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.+�•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C own i ear
�... ,= FOR DEDUCTION FROM ASSESSED VALUATION
� State Fartn 43709 (R8l 2-07)
�'' , � Aesaibed by Department of local Govemmrnt Firence
i a
INSTRUCTIONS:
To be filed in ,cerson or by mad wrth the CountyAuditoi ol the county where the pmpedy is bcated. �--y�� ��
FJing Dates: 1J Real Property: During the 72 rtronths 6e/ore June 17 oJ fhe year the deducbon is fo be elfec6ve. O'��
2) Mobile Homes assessed under IC 64.7-7: Behveen January 15 and Ma2h 2 0! the year the deduc6on is to be efl
See reverse sida for additional insWctions and qualifications. GIBSON C Pil' AUDITOR
Applicant (owne� i
��
01 Co- /3 -�i' - /C�-�/. 3aG-�
popgty a d March 1, anenl year Mptgage / ConiraG in�tl/eWedness unpaiE as of March 1,
curzent year /( 0 � b .
is his / her ezaq share of inleresl?
m record is
rtwr�qagee or conLaU
rtartga9ee or mnlraa seller (num6er an0 sVeet. dty, state. aM ZIP cnde)
Name of assi9rree or aU�er owner or holder of mortgage
Address of asvgnee (mm�6er aM sfreel,
property in arry Wher If yes, what cwny? I What Taring Dislrict?
❑Yes ❑ No
Is �he appFmnt Ihe sde legal
❑ Yes ❑ No
spouu.
is the property in questlon:
❑ Real Property ❑ Moble Home (IC G7.1-7)
�991r aa
Has Uis deduciion been requestetl on praperty
fw wrtenl yeaR
❑ Yes ❑ No