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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u o Year
__ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R71 / 609)
� / Presaibed by �epartment o1 Lofal Govemrtrerd Fnaxe ��
File Mark
INSTRUCTIONS: �, �,
To be filed in person or by mail with the CountyAuditor or Counry Recorder o/ the county where lhe pioperty is located.
Fi/irg Dates: 1) Real Property: Must file dunm� the year /or wflich Ihe deducfion is soughL � A��qR,ertnr
2) MobAe / Manufac2red Homes rat assessed as Real Property: Must fiie dunng the hveNe (72)�ow�n N C U
6e/ore March 37 of each year the deduclion is sought. �1°°`� Counry Recorder
See reverse side for addifaonal instructions and qvalificaf'ans.
Aoo6canl (ownor orcon7raQbuYer �see mstricliv4t on �averse ' el
I ralue af real P�P�Y %5
apmrt yr2r
eua
Key number / legal d�aiption
� I�-zo-i5-3� c�s�36� o0
—rMongage � contract iMehteaness unaab � � Monpa
sameorre
C"f.Ferent lhan that of app6mnt, udkate hebvr.
Name of rtiortgagee or
aea��ss ot �mrts�9� «oono-aa sc
Name af ass�.p�ee w athu awner ar
1!f'�f.t.e.�",�'i➢
saee4 �Y• uate. ana ar coae�
property in any other I If yes. what muntyl I NTat Tadng D
❑ Yes ❑ No
De�umon appmveC in tlie amwn
� �
Sig(anneNCounbAUditw ��
20 � 20 � 20
Record numbu Pageyumbel _
I � �J� �
oteEness �mpaid a d Is ihe ePP�t Ne sole
legal or epuilade ox�el.�
❑ Yes ❑ No
spouse. 6dkafa wArti H1am
AAIs--IYYMpp,,p,,,,m,,''paty m 7ues0on: MnuaOy Assessed
y�•��PenY ��Y�
� — Ma6�e Hane QC 61.7-7
Drawer NO....°���.b
Card NO. .....�U�
������ ��
20
Date (nanth. daY• Yea�
20 _
I I We cert'rfy under the penalry of perjury that the above and foregoing infortnalion is W e and correct and that Me applinnt is a resident of Indiana aM
owner I mntract buyer ot the aforementioned pmperty on date application is filed.
s+ree4 �; s+ate,
ezewtetl Power af Auorney or by IC
of aNha'vtd persm (num6er aM SbeeL uy state, an0 ZlPmtle)
� ��