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...�•* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u' s p Year
,� FOR DEDUCTION FROM ASSESSED VAWATION
. Slale Fortn 43709 (R8 / 2-07)
�0�� •� Presaibed try Department of Local Govemment Finance
•r
File Mark
INSTRUCTIONS:
To 6e filed in person or by mail wifh the CountyAuditor o( the counfy whera Ne piopeRy is located. � `�jj� ��
fdinq Dates: 1) Real Pmperty: Dunng tbe 72 months be/ore June 77 0/ the year the deduction u to be elfecGve. �` r
2J Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 2 0/ fhe year the de�i{��t to� .�U JDITfiR
See reverse side /w additional insWctions and qualifications.
;own r w mnlrad 6uye� - see � ons qp{everse 5itle)
L CJ�'�C� �
aria Key number / legal tlesaiption Rem�d number Page number
1z�v �� -��-a.3 -300 -oov.o3o-ooY 0 8� �
ralue of 2a1 pope�ty as af Mamh 1, amnt year Mortgage I ConVad intlebledness unpaid as of March i, Is Ihe appGnnl ihe sole legal w equilade o.vne(1
artentyear . "
l-�oZ 00D ❑Yes ❑No
If no, whal is his / her ezaG share of irrteresl7
rume on
Atltlress of mortgagce a mnUaa seller
Name of assigrree or olher owner w hdtler ot mortgage
Address of assig�e (number aM sGeef, dty. stele. end
Ooes applicanl own pmperty in any otner
counry in Indiana?
❑ Yes ❑ No
mmeone a9her ihan spause.
�elow: Is Ihe property in question: �
�—
❑ Rea� °-- - 'IC 61.1
�v�J� S-,B 1 � 9� �,(0 7
dIY. stafe. erW ZIP code) ���.: ` T r.a\1� Ql � O•••• • �
ll
C�Yd \� .
!
Whal T�ing DisVict? Has this deduction bean requested on qoperry
fa w�n y�n
❑ Yes ❑ No
COUNTYAUDROR
Deduction approved in the amount of:
20 I � 20 20 _ 20 20 20
SignaW re ot Counry Auditnr Counry Date (manMi. day. yea�
I/ We certify der the pena�ly rjury that Me above and fwegoing infortnation is true and correct and Nat the applicants was / were a resident of
' diana and er of the afore ntioned property on March 1. 20
awre (owne/s lull nertre) Date (monfh. day, yea�
Fu0 re! tlenl atldiess of applicant (numbei antl sfreet. cdy. state. arM ZIP cade)
3�(�o E asDs N���u7o
Permn auihorized by tluty e:ecuted Po.ver M Al�aney w by IC G7.1-12-.07 Ua�e (mmth, day. yee�
Atltlress of authoraed person (n�mber aM sbeet. cty. stafe, aM ZIP mtle)
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