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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
'±. = FOR DEDUCTION FROM ASSESSED VALUATION s' Year
` / State Fwm 43709 (R6l 5-06)
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�• Presctibed by Depenment of Local Gwemmant Finance
MAY 1
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county whe�e the properfy is located. `�j7 µ�j�,
Fifrng Dates: 1) Real Property: Dunng the 12 months before June Il of the yea� the deduction is to be etfeciiv`�Q ('/
2) Mo6ile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the }���tltYJ34bN i�kf�b��'Iective.
See reverse side for additional instructions and quali/ications.
or
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- see restnctlons on �eve�se
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Kev number / lei
Auessed value of real property as of
March 1, curtent year
If no, what is his / her exact
If name on record is different
Record number !� /
lJ �'�
�G-�� -07 -�(O/ — 000• Y96 pagenumber 7 3 3�
Od,�
Mortgage / ConUact indebtedness unpaid as of Is the applicant the sole legal or equita
March 1, curtent year owner? Q Yes � No
��� � o 0
If owned with someone other than spouse, indicate with whom.
znt, indicate below: Is the property in question:
� Real Properiy � Mob�le Home pC 61:
�me of moRgagee or contract seller /�
�1GTu�d
Address of mortgagee or contract seller (number and street, city, sfate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and street,
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20
Signature
20 08
�
If yes, what county? � What Taxing
COUNTY AUDITOR
20 Oq 20 20
P
County Auditor
%�'1 v /"f
G�y sv�vc,�ANT- --
CF�r-NE��
��� 733 � I �
No
20
Date
20
We certify under the penalty of perjury that the above and foregoing infortnation is We and correct and that the applicants was / were
�:sident of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
atldress o pplican[ L ,(� Atldress of authonzetl person
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