State Form 43709 - Statement Of Mortgage Or Contract Indebtedness For Deduction From Assessed Valuation - 2003

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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Township
County
Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R5 / 4-03)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be effective.
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 for additional instructions and qualifications.
Applicant (owner or contract buyer - see restrictions on reverse side)
Taxing District
Record number
Key number / legal description
Page number
Mortgage / Contract indebtedness unpaid as of
Is the applicant the sole legal or equitable
Assessed value of real property as of
March 1, current year
owner?
Yes
No
March 1, current year
If no, what is his / her exact share of interest?
If owned with someone other than spouse, indicate with whom.
Is the property in question:
If name on record is different than that of applicant, indicate below:
Real Property
Mobile Home (IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other
Has this deduction been requested on
If yes, what county?
What Taxing District?
county in Indiana?
property for current year?
Yes
No
COUNTY AUDITOR
Deduction approved in the amount of:
20 ______
20 ______
20 ______
20 ______
20 ______
20 ______
20 ______
Date
Signature ________________________________ County Auditor
I / We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20 ______.
Signature (owner's full name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident address of applicant
Address of authorized person
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Date filed
Name of applicant
Name of mortgagee or contract seller
Amount of indebtedness
Taxing District
Key number / legal description
Signature ____________________________ County Auditor

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