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"'* STATE�OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
s.=_
: FOR D�OUCTION FROM ASSESSED VALUATION
• Stata Form 43709 (R71 / 6O9)
S 1 Presaibed M �ePM�rLL of Laal GovemrtreN Rrmnce
�«.
INSTRUCTIONS:
To be filed in person w by mail with Ihe CountyAudROr or Counry Recorder oI the county where the p rty i .
Filing Dates: 1) Real Property: Must fi/e dunng fhe year for which lhe tleduction is sought.
2) Mo6ile / Manufactumd Homes not assessed as Real Property Musf fi/e dunng the hvelve (72) �n�s
6etae Ma�ch 37 of each year the deduction is sought.
See reverse side (or addiL"onal insVUCtnons and qualil�catbns.
ro���c�,�,,�qn�-��u,��„���strr nn _ o
Tab�g Disvict
County AudilDr
Gounry Recader
-1.�' U- 5y - S LJ(o v"
d value d real pmperty as of Mor�qage / Contract indebtedn�.s unpaid az o( Mortgage I CanVa�Y indebtedness unpaid as of Is Ne app�rant Ne sole
wrent year Ma 1,pyrent tlate of aDP����� legal w eQUitaWe avmeR
V ❑ Yes ❑ No
a� is itis ! her ezact share of interesi? If ovmeC vriN sameme other than spouse, 4dzate wtth wtwm
m �ecorE is difterent Nan Nat a( appOCani, indicate bebw. is Me praprm� in QuesOaa�: Mrn�aDy ASSesseE
❑ Real Fvperty Q Armuaih� Assessed .._
Name of irotgagee or mntracc se�ler
Address of mortgagee w convact seDer (num0er aM streel, rJry, sfate. erM LP rotle� '
Name oi assignee w athrl owner rn hdder A mortgage
` Dra���er NO...���.P.......
Addrea of assignee (number and stree; dry, state, and ZIP mdE
Iipnt ovm property in anY oNer If yes. wh C a r d �\r �. . . � �� • � . . . . . • • • • . �uc�c
IMiana? ❑ Yes ❑ No . �� yeaf!
DeCUGion apprwed'c� tl�e amount
20 1� 20
��
SignaWR o(
Ci9
`Q'�� G�� � lSli
� �
County
�
req�estea a� prov�`i
❑ Yes ❑ No
Dale (ma�M. daY• Y��)
20
I I We certify urWer ihe penalry of peryury Nai the above antl foregoing infortnation is We and cortect ark Nat the applipnt is a resident of Indiana arM
owner / wntrad buyer ot the aforementioned property on date application is filed.
vanuafewne/s MI rramel �. Date (month, daY. Y��
_-- /�'l' L f�
fapp6rant(numberarMSbee4 aN.
Oy IC E7.142-0]
person (numberaM shee4 �ry. s+aR.