Mortgage_Reeder (2)�► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09)
�, w�' Prescribed by Department of Local Govemment Finance
nvsrRUCrioNS:
Count Township Year
�
Form fil cj,�i(h:
US
To be �led in person or by mail.
Filing Dates: 1) Rea! Property.� Must be completed and dated in the calendar year for which the deduction is sought. MA 6 County Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located ecorder
on or before January 5 of the immediately succeeding calendar year.
2) Mobile / Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the
county where the property is located during the twelve (12) months before March 31 of each year the N COUNjY AUDITOR
deduction is sought. G�B$�
Deduction approved in the amount of:
20
Signature of County Auditor
20 � 20
COUNTY AUDITOR
20 20
County
20
Date (month, day, year)
20
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner / contr t buy of th aforementioned property on date application is filed. Date (month, day, year)
ature (owne f II na ) � (1, � ,, _ \ ,('7 „ � _ / �—j / 2013
Full resident address of applicant (nu street, city, state, and ZIP code)
705 East John Street, Fort Branch, Indiana 47648
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7
Address of authorized person (number and streef, city, state, and ZIP code)
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Date (month, day, year)