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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ship Year
_,_ FOR DEDUCTION FROM ASSESSED VALUATION �
. S�te Fwm 43709 (R71 / 6-09)
` Presrn�Oetl M��M of Lttal Goremmertl Fuiance
"° de Mark
iNSrnucno,vs: �� 0 5� F� nma�n:
b 6e filed in person or 6y mail wiM Ihe Co�ntyAuditor or Counry Recorder o! the counry whera the property ted.
FrHrg Dates: 7) Real Property Must file dunig the year lor which the deduction is sought Counry Auditor
2) Mo6ile /Manufachned Homes not assessed es Real Property Must file dum�g Me hvehre (12��q�pnNs Q � ���, Recorder
6efae March 31 o(each year Ne deduclion is saqht. Q�� "}j
Sae reverse side (m additional insWCGOns and qual'rfications. SpN COUNTY
I MP�m (amer or mntrae buyp�' seq restricaons m re�xrse sida� 9
M� W�Id� 6 �IIS ��12f C%dL15�ldI8 Oi VI{PlESIi
- 3 3 �s cb
ract' �tedness unpaid as W Morigage / Contrea mdebtednrs
t yeer data o( app�tbn
�
rc owne0 wiM sameane dher Nan spause.
�} 112TC Ofl RWIf� 6 QIi�PRfli i�1311 ald� Oi dp�Qll�� �Ifd}2 �2�PK.
Name ot rrorp7agee «mntraU seller
AddRSS ot rtqrtga9� ar mntrac[
owner or hoNer M rtprtgage
(number arnd stree4 mY. �ta, end
Ooes epplimnt ovm property in any oNer
county in Intliana> rl .,_ _
sbte, aM LP cale)
RecaN num6er
��a���a�
legal a ep�+(bde vardl
❑ Yes ❑ No
�$ pIC pfppCfly 111 QYGSLpI: i1f111U'd� I�43G45Ed
�f Real PmPeKY � ?�!��!�Y �
Dra���cr NO.....P���.1.....
Card NO. ...JJ..�.`�..�........
VY�aI I� /1� 1, �O�Y
_ '^ 1 1 ��V. l�� ❑ No
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