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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RS / 6�3)
PresaiEed by Departmeni of local Govemment Finance
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Coun Township 1 Year
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INSTRUCTIONS: �"lj��File��.
To 6e filed in person or 6y mail with the County Auditor of the county where the property is located. � n, � �� 7Y nUD170R
Filing Dates: 1J Real Property: Dunng the 12 months before May 11 of the year the deduction is to b�ellectiv�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side Ior additional instructions and quali(cations.
(owner or contract
Taxing Districl
see restrictions on
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Assessed vatue of real property as of
March t, curcent year
If no, what is his / her exacc share of interest?
If name on record is different than that
of mortgagee or contract
side) �
Key n�nber / legal de�cription Record number
�1.,/,t-/8 �.o3'DDO•,83Y-o,t8 O (o
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MoAgage / Contracl indebtedness unpaid as of Is the applicant�sole legal or equitable
March 1, current year owne(? es ❑ No
a
If owned with someone other ihan spouse, indicate with whom.
indicate below:
Address of mortgagee or contrad seli�l (number and street, city, state, ZIP
Name of assignee or olher owner or holder oi mortgage
of assignee (number and sfreet, city, state, ZIP code
Dces applicant own property in any other l If yes, what counry�
county in Indiana? �
20
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approved in the amount of:
20
property in question:
�eal Property p Mobile Home pC fr1.
Dra��•er NO. �. �.::5� � %
Card NO . ....................
COUNTY AUDITOR
20 20 20
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County Auditor
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Date
�tion been requested on
urent year?� Yes❑ No
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March t, 20
Signature
address
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person