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""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
-r=_
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfale Fartn 43709 (R71 / fi-09)
�' 1 Presaibad by Departmem of Lo�i Govemment Finance
INSTRUCTIONS: p
To be filed in person w by mail wifh the CounyAUditor or Counry RecoNer of the counry where the pmperty is bcated. �j L���� � �
Fifirg Dates: 7) Real Pmperty: Must file durrng the year /or whicA fhe tleductlon is sought. � Counry Auditor
2) Mo6�le /Manufactured Homes rrot assrssed as Real Property Must file dunrg the fweNe (12) monfhs
befole Ma2h 37 0( each year the deduction is saght. ��� Recorder
See /everse side for adtliG"onal instlucGons and quali6cations. ___ __
m
Key number / te9al d ' ' � Q Reoord numbu Page numEu
• a�-a - b�-aoo-000.8a3-oo ao� 3s3
real V�`D�•Y es d Mortpage / Contract irdehtetl(ress unP� az W Mortgage / Con:raG "uWebtedriess unPaid az d Is ihe eP�t Ne sde
ar A1ar� 7, artenly� Aate of appGntion legal n equilaNe ameR
S/ SOD ❑v�❑No
twf exaG share of inte1rs17 If owned wiN somerne oNer Ihan spouse. uMicate wBh wtam
's ddfurnt Wn Wt d appfran� uWUare Gelmr. the P�oP�rtY in puestiort MfwaDy Assessed
RoalPmrwrn._C'l.n...,._a.."'___ '. —
Name N mort9a9ee or mntrarl
mntraq seder (numher end streef, �y, sTate, arN LP code)
Name W assignee w oNe1 wmer a hoNer o( mort9a9e
ntl e4 my, slate, and Z/P code) �� /�l ��
�G� i��
any other If yes, what wunry/1 NTat Tavrg DistriG7
Dra�r�cr \0...°.(.���I.........
Card NO. ...�3�........
$ ����.�
i
Has Nis detluaim Eeen requestetl m prtperty
for aurent Yea� r-� __ r�