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"'� STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
• FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R17 / 6-09)
�' Presrribed by �epartmeM a( Loml Govammerrt Firence
INSTRUCTIONS:
To 6e filed in person w by mail wiM tha CounryAuditor or Counry Recorde� of the counry where the pioperty is focated.
Fi7'mg Dates: 1) Real Property: Must file durirg the yearlor which the deduction is soughG
2) Mo6Be / Manu/aUuled Homes rat assessed es Real Pruperty Must fife dunng fhe fwelve (12) months
6etae Maich 31 0l each year Ne deduclion is saight.
See 2verse side lor addilional inshucGOns and qualifications.
AppGwnt (owne n Duyernsee msLi�ons m resxr�se side) .� M _'--
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R m. wha161�a � Mr er2a
i Ilaltl2 OI11ClVfti 6 QT1CfPJ
'HUo(— (7C.1CJ. ol jj 6'C
u(gage / Contract indebtetlness unpaid as ot
6C�0`K.
Name o( mortgagee ar conVad se9er �'r�
/
Address W fm¢7agce w mntract se0er (num6er and sveel, ciry, stafe, erM ZlP mde)
Name of assipiee or oMer ownet w Mider ot nwrtgage
Ad7ress of asseg�ee (numba� ard atreel, cdy. s)affi, aM LP wQe)
SoR12W1E
Dces eOP��� ovm D�PenY in any atlre+ R yes, W�at munq?, '':. i- t Tadrg �?
munty in Indana? .._'"—
❑ Yes ❑ No � .• ..
ueaurnm aPWO+� m ure amoum ar.
zo zo
s��an,re w co�a �ana�
I I We cerbfy under the penalry ol
owner I�f�-ad buyer oi ihe afa
pe�m� (num�er
d��0- 50��
� 9 �� yio6 �°
� . /�_. -�- �, .-�-�
�mpaiE as
Year
� C�oTuntyq Auqditq/r��
❑ �BoLniyR6CdrdE/O
numbu
ves u No
Is U�e P�C�Y in GuesUOn: Mnua�y As,usse0
❑ Reai RoPeKY ❑ A"^ua11Y Ps�s�
Abbile Flortie OC E7.
Has ihis deductmn Eeen re9ursted m proprlty
tor cu`rent yraR ❑ Yes ❑ i
2i1
,�
,innt is a residerrt of Indiana and
ate (monfh, day, yea�
a�,,�.�Y�