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.�-=s* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u s Year
�• '
� FOR DEDUCTION FROM ASSESSED VALUATION
S�ale Fortn 43709 (R8 / 2-07)
���; ` Presvibed by Depariment of Local Govemment Finance MAR 2 0 2009
File Mark
INSTRUCTIONS: � �
To be filed in person or by mail wfth the CountyAuditor o/the county where the property is located. - 6'�
Fding Dates: 1) Real Pmperty: Dunng the 72 monfhs before June 17 0/ the year fhe deduc6on is to be e/fec6ve. �� UD170R
2J Mobile Homes assessed under IC 61.1-7: Balween January 15 and Ma2h 2 oltha year the ded@1894TN��iJi�ciiv�
See reverse side /w additanal insbuctions arN quali(cations.
Applicant (owner wcontrad �� see reshicfi m reverse side), /
`i �!
Ta �g DisUict . K y number I legal desaiption
a� - i- �- 3 0-��i. 3�� - o 0
0.ssessetl value M real property as d March 1, amenl yeer Mortgage / ConUap indebledness unpaid as of March 7,
cvrrent year
� 9 900
�. what is his I her exacl share of imerest? If owned someone dher �han
If rame on
Ihat of applicarri, indinte below:
Name of mortgagee ar conUact seller /
� / �
Address of moM1ga9ce « mnirad seller (numbel aM sheet.
rnvner or holtler ot mMgage
�er ara sr�eei. dry. :w�e. a�e z�a mae)
applicant own property in eny dher
y in Indiana7
❑ Yes ❑ No
Deduction
��1��
It yes, wha� counry7 Wha� T;
'i
'1
,' 1
COUNTY AUC�.'{
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�
�
zo _ zo 'r'
`:i
Counry
Remrd number Page numDer
� a-a0c� 360 /
Is Ue appGrant Ihe sde legal w equitade ameR
❑Yes ❑ No
spouse, indcate wilh wFwm.
Is ihe properry in question:
❑ Real Pmperty ❑ Mobile Home pC 61.
�
uestetl on prope+ty
❑Yes ❑ No
Drativer i1'p �,O°�- ,�6,0
� .�
Card NO. ...........�., zo
. �
I I We certlfy6/nder the penally oi p�jury that Ne above and fwegoing infortnation is true and mrreU and fhat the appliwnts wa., .. � a resident ot
Indiana and owner of tlie atorementimed property on March 1, 20
`r(owne/s hAI na e) Date (monN, eay, yea�
l
/ z%/i / ��
� tlenl adtlress of applicant (numbe tl sfreei. cdy. sfele. arM ZIP wde)
�8 S G5a E k)a���.����t 47c��o
rson authorizetl by duy exewted Paver of Attomey or by IC 67.1 2-.07 Date (monN, day, year)
Atltlress of aulhor¢ed person (number aiM sheel.