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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'' FOR DEDUCTION FROM ASSESSED VALUATION C un T Year
�''. w� ✓ State Fortn 43709 (RS / 4-03) C
� PrescnDetl by Depanment of Loral Govemment Finance ' APR 9 ZQQU
INSTRUCTIONS: �7a�., ��a�
!� "
To be filed in person or by mail with the County Auditor of the county wAere the property is located. pUNTY AUD���R
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 of the year the deduction is to�Sl���I(�e.
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to 6e effective.
See reverse side for additional instructions and qualifications.
contract
Taxing
Assessed vatue of real property as of
March 1, current year
If no, what is his / her exact
restrictions on reverse side)
Key num er / legal de
O/�-G�/
Mortgage / Contract i�
March 1, currenl year
7� �
Record number
Page number
unpaid as of Is the applicant the s61e legal or equitabie
ownef? [,}¢es ❑ No
If owned with someone olher than spouse, indicate with whom.
If name on record is different lhan that of applicanl, indicate below:
'me of mo �agee or contract seller
Address of mortgagee or contrad selle nu er and st2et, city, state, ZIP
Name of assignee or
Address
owner or holder of mortgage
(numberand slreef, city, state, ZIP
Does applicant own property in any other If yes, what county? Wh
county in �ndiana?
Deduction approved in the amount of:
20 _�2 20 Q$_ 20 O 9
p � P
Signature
COUNTY AUDI
20 20
County Auditor
Is the property
❑ Real Proper
❑ Mobile Home QC 61.1-�
�o..c?�......
Dra�ver � 9� 1
.....
Card i�,'0 ��Q,� oe '���P
`fy ��- �1�4� -
20
Dale
20
iested on
Yes ❑ No
certify under the penalfy of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned propeRy on March 1, 20
Person authorized by duly executed Power of
or by IC 6-1.1-72-.07
of authorized person