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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township vear
_, FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fwm 43709 (R71 / 6-09)
� Presvibed by Department o1 Local Govemment France
� File
INSTRUCTIONS: JAI
b be filed in person w by maii with the CountyAUditw orCounry Reco�der of Ne county where the pmperty is located.
FiNrrg Dates: i) Real Pmperty: Must Rle dunrg the }rear /or which the deduction is mught.
2) Mo6ife / Manufaduied Homes rat assessed as Real Properfy Musf file during the nrelve (12J months '�'
6efore March 31 0/ each year the deduction is swght.
See reverse side Iar adtlifional instnnYbns aM qualifications. C' �BSON C�
pypfrant (owner u - see resfi�Sms o�e side) e �
ed vaWe a�irai PWPn�i as af
1, amnt yYar
M. Whd1 f5 h15 / hEf GYdf2 Sh316 O( V11C1¢Sl?
If fame on 2mN
r�ame m ��� «
e�
w oM� wmer or naaer ot mmyage
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le / ConbaG Intlebtedness unpaN az U
. arrent yem
stam, aM LP oode)
ot assynea (nurwer ana straet, dA: s�ate, ara z�F code)
Does epplirenl wm poperty in any
munry in Irdiana? rl .._.
Re[order
Retnrd numba Page numEu
imP� as the e0d�t Ne
legal or equita6le oaneP
n Yes ❑ No
Is 1M propaty in 0�+� Mnua�y Assessed
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ta artent yeaR ❑ Yes ❑ N