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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ s FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R71 / 6-09)
�,«. � Presa�betl M�N o1 LocW GovemrtreM Fuunce
� � ��� � File Mark
INSTRUCTIONS:
To be filed in rson or b mail wiN the Coun Auditw or Coun RecnN th re e ro F� �� ��
PQ Y N N P PertY is locafed.
Filing Dates: i) Real Property: Must fJe durirn� tAe year /or which the deduction is soughG Counry AuAitnr
2) Mobde / Manufactured Fbmes not assessed as Real Property MMS1 �ellc�n�kweNe (72) months
6efore March 31 of eacA year the deduction is sought. r�r County Recorder
See �everse side Por�dditional instmclims end qualdirafions. � C��--.-1
snare or mteres7z
If name on �emrd'a 6tfemnt Nan Mat M app�caN, uidica[e below.
Name W rtartga9ee or mntrav se9u
Addr� of mort9a9� or mntract uou (num4v arci sa
Name o1 asvgnee w oNer owner or halder of mortgage
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Person ai
° a(�-�y- i 8-`fo.3.
aci iMebtetlness unpaW as of Mwtgage / Contra
ye9r� � � date o( applkatun
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someore aher Ihan spwiu.
7rree (numDar eM stree; tlry, stete, aM ZIP caCe)
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legal or eputta6le o+rtrell
❑ r� ❑ No
wi�om
15 tlre WaaPenl' m 9uPStiDn: Mmia�Y Assessed
❑ Real Property ❑ MnualyAssessed
: this deduction Deen re9uested m v��Y
vrtent yeaR ❑ Yes ❑ Nt
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oa�e a�o,un. ear, r�A
� applinnt is a resident of IrMiana amf
Date (nw�fi. daY. Y��)
7 / � � 0
Date (rtronN. daY. Y��