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.•�—'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ; To ip Year
,,.: � FOR DEDUCTION FROM ASSESSED VALUATION
Stale Farm 43709 (R8l 2-07)
°����. � Presaibed by Depanment of Lacal Govemment Finance n,
File Mark
INSTRUCTIONS: � � v
To be (led in person or by mail wdh the CountyAuditor of the county where the property is loceted. � �.�,., qu�
Fi/ing Da(es: 1) Real PiopeRy: Dunng the 12 months before June if o/the year the deduction is to be e/fecGve. �J �
2) Mobile Homes assessed under IC 6-1.1 J: Belween January 15 end March 2 0/ the year the deducQpggQq.p�9�(9t.YIVe. AUpITOR
See ieverse side /w addifional insWCtions arrc/ quali�cations.
(owner a
vdue of real popaty as
see ies�tims m rev�rse side)
number / legal desaiplbn [� Recoid number
� '/9-3/_,ja3 . oa�.88 y-ao 9 aoos
1, ament yaar Mongage I ConUad indebtedness unpaitl as M March 1, Is Ihe app6cant the sda I�
anenl year . „ _ _
of iMe25�?
m recwd is difFerent Nan Ihat of applicant, iMicate below:
Name of morlgagee or contract seller �
Adtlress at rtaM1gagee a cmlraG seller (numbeY a�� f, dty, state, and ZIP code)
w oNer owner or holder of mMgage
Address oi assgnee (num6er eiM sLeet, dty, state, and
Dces applicaM own property in arry olher
counry in Indana?
❑Yes � No
approvea in the amount of:
� � � � ����
yes.
20 I 20
It axned wM someme dher Uw� apouse,
Page number
or equitable oxner
❑Yes ❑ No
� aoo� ��9��,.
Drawer NO..........:.
�Card NO . .....................
3 �tl� �/30.00a,o� _
Whal Texing District? Has t�ia tledudion been requested on property
fa arrerd yeaR
❑Yes ❑No
AUDROR
20 � 20
Oate (rtanth, dey, yea�
20
I I We certify under the penalry of perjury ihat Ne above and foregoing infwmation is We and cortect and that ihe applirants was I were a resident of
Indiana and owner of the aforemenfioned property on March 1, 20
Person aulhorizea
slafe.
aM
pe1sm (number and slreeL aty. slste, and
Date (monfh. day yea�
yeeA