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���"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's• � FOR DEDUCTION FROM ASSESSED VALUATION Count ___Township r
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! SUte Fortn 43709 (R6 / 5-06) - �+ 1 j
� Prescribed by Department of Local Gwemment Finance �
FEB 1 9 2008
INSTRUCTIONS: File Mark
To be filed in person oi by mail with the County Audito� of the county where the property is located. '—yr,� � y_ __
Filing Dates: 7) Real Property: Dunng the 12 months before June 11 of fhe year [he deduction is to be ef/ective. �� �� "�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the Qad�@wrJBtCK�(e1F�ff15pR
See reverse side for additional instnictions and qualdreations.
Disirid
contract b�yer - see
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.
Assessed value of real property as of
March 1, current year
no, what is his / her exad share of interest?
on reverse
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Key nurt�er /lega�escription // f
o� 6-�o - DoT -�-o Y' cbaY
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MoAgage / Contrad indebtedness unpaid as of
March 1, current year
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xd number �D � 7
: number / - �q�
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Is the applicant the __ 'egal or
ownef? ❑ Ye� ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below:
e of mortgagee or contract seller
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Address of mortgagee or contract selier (number an treet, city, state, ZIP
Is the property in question:
❑ Real Property ❑ Mo6ile Hmie
Name of assignee or other owner or holder of mortgage � t, � ,
-a�ser i\'0....�(� 7.
Address of assignee (number and street, city, state, ZIP code) �""
C:11'(� 1���. ���.
Does a lipnt own ro e ����' �
pp p p rty in any other If yes, what counry? What Ta ""'
county in Indiana? °� �5�. �
COUNTY AUDITOR
approved in the amount of:
20�� 20
P
20 20 20
County Auditor
20
Date
20
; d on
��No
certify under lhe penalty of perjury that the above and foregoing information is lrue and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
�6�� IAddress of aulhorized person