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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
SUIe Form 43709 (R4 / 1 P41)
Prescribcd by Department of Local Govemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the County Audifor ol the county where the property is locate S1[
Filing Dates: 1) Real PropeRy: Dunng the 12 monfhs belore May 17 o/the year the deduction is ectiv.���7'`1-�
2) Mobile Homes assessed under IC 6-1.1-7: Between January f 5 and March 31 0( th�3�§�l'f�bi�hctian4s'to-b'e ef/ective.
See reverse side (or additional instructions and qualifications.
Applica (o � or cont c buyer- see res ' ions on reverse side)
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Taxing/ D�istrid Key numtier/ legal desuiption Record number O�
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cunent year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? f owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Propelly ❑ Mobile Home_(IC 61.1-�
�me of mortgagee or conirect seiler -
Drawer NO..�:�•�•%�°Z•3
Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Card NO . .....................
Address of assignee (number and stieet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has lhis deduc[ion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
�'/ We certify under the penalty of perjury lhat the above and foregoing infortnation is We and corred and ihat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owner (ull nam Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
Fu I re dent address of appliqnt Address of authorized person
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