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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
:.--..
: FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R71 / 609)
S f pf�yty p�, pe��� 01 L.aml GoremmeN Fu�ance
INSTRUCTIONS:
To be filed in person or by mail with fhe CountyAuditor or Counry Recorder of the county where the property is located.
Fitirg Dates: i) Real Pmperty: Must file durrrg the year (or which the deductlon is sought.
2) Mo6de / Manufactured Hortres rrot assessed as Real Property Must fiie dunrg the M1velve (72) months
6efore MarCh 31 of each year Ihe deducFOn is srought.
See reverse side for adtlilional insfruUions arnl quali(icatbns.
I MP�9�'ibwnerpr cont2C Dyy�r- see ie;?+CQuns,a�reverse s'sie)
AsesseC vahe d real PiopertY as d
ARarch 1. aare�rt yw
If M, what Ls his / her exatl sliare ol
Ii nartre at �cofd 6 tliflerent Utan u
Name ot mataaaee ar contract selh
2c�i,�m�
Counry Remrder
nber/Ie�Ides�Lp� ��— C 6.LJ — W Recofd^/ / Pa�ef4��
Y lJ W %�
Mwtgage / Contract 4WebteOness unpai0 as W MMgage / Contrari udebtedness unpaid as of Is Ne app�rant Me sole
Mamh 1. artent yrar date of appficalion legal or eQuttahle rnmeY.+
� ❑ Yes ❑ No
If owne0 wiN wmeo�re other than spouse. iMicate with wlwm
�nt, mdirate beb�r. is ihe property in QueSCOn: Mm�elly Assrssed
❑ Real PtoPeKY ❑ �!+�h!� . . _
ot rtnrVjagee w mntract seUer (nuMer aM slreeG �y, sbm. ard
Name o� assi�ee a othei avmer ar hdder of mortgage
Mtlress ot assignce (number eM stree4 ay. stete,
Does e�imnt own ryoperry In any o1
munry in Indiana? ❑ Y�
Deduction approved in the amoura of:
20 � 20_
of Counq' AuEhar
I( yes. what munty?
No
COU
20 _ 20
/
�,T�- p �03��
= i���� �anl�
\UDR� � �
ll
20
Y��
20
�
i I We certify urWer Ue penalry of perjury Ihat ihe above and foregoing infortnalirn is We and cortecl arW that ihe applinnt is a resident of Indiana arM
owner / contract buyer of Ne afwementioned property on date appiication is filed.
�) Date (month, daY. Y��)
FplilfvCent address of appfirant (numDer and streef, fity. slate, and ZIP m
�z l( S- YNa�n. Sf' �-avbslcdt , -L�
Peison autlnReE by duty execu;etl Power of Attamey or by IC 6t.7-72-0.7
Date (monN. daY• Y��
Ce�wn (numOer aM sLee4 ury. sfate, antl LP code) . ' . /
N