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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
mod- FOR DEDUCTION FROM ASSESSED VALUATION ? r
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State Form 43709(R11/6-09) I t !
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Prescribed by Department of lad Government Finance c '
File Mario .7
INSTRUCTIONS: -„- , y .
•To be filed in person or by mail with the CounlyAuditor or County Recorder of the county where the property is located. •2014
Fling Dates: 1) Real Property.Must file during the year for which the deduction is sought ❑ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the tweNe(12)months
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before March 31 of each year the deduction is sought ��1 f�,•,� _� �r
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See reverse side for additional instructions and qualifications. TY Ammo-
i"ITOR
Appeumt 4),A, or contract brit-sefrabictions u /TIC o /v z /o vaoo. (0oo- o6 2 P�(J number,
—� vadm of rpl{�o(>em/as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mash 1;current ye�r// March 1,curere year date of ap • legal or equitable owner?
/op ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than space,indicate with whom
If name on record is different than that of appbcant,indicate below: Is the properly in question:Annually Assessed
❑Real Property ❑Annually Assessed
,,••99 Mobile Home(IC 6-1.1-7)
Name of mor�t mice or contract seller //se /`E/J vi
Address of mortgagee or contract seller(number and street city, 'Y3�/tee aanndd ZIP code) %��v�pvf�,��//,
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) -- — _ --
Does applicant own property in any other If yes,what cot 3arri- }vim/ been requested on property
county in Indiana? VVV
❑ yes ❑ No ❑ Yes ❑ No
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Deduction approved in the amount of.
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20_ 20 20_ m 20
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Signature of County Auditor County Date(month,day,year)
I 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 I•■ tract buyer of the aforementioned property on date application is filed. .
Signature NO name) Date(month,day,year)
authored by duty executed Power of Attorney or by IC 6-1.1-12-0.7
If Date(north,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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