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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wns r
-. --
_ FOR DEDUCTION FROM ASSESSED VALUATION
�� State Form 43709 (R71 / 6-09)
� y„ � PresaibeG by Depariment of Local GovemrtreM Frence
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INSTRUCTIONS:
To be filed in person a 6y mail with Ne CounryAuditw or Counry Recorder o/ the wunry where the properry is located.
Fiting Dates: 1J Real Property: Mus! file dunrg fhe yearlor whicA fhe deduction is sought. n ditor
2) Mo6de /Manufadured Homes not assessed as Real Properly Must h7e durirg the twelve (12) monU$ �gS N C(7p N !�n�
6efore March 31 0l each year the deducfion is sought. L7 ��iY'*<���
See reverse side for addiGOnal instnrclions and qua/�cafions.
�istrirl Key rn�mber / leqal d pUOn
M ' O � �
tl rdue d 2al popn,nY as d Mor�qage / Cantraa intlebtedness unGaid as
,armntyrar Marchl airtent
�at is his / hef eF3d 5h8re Of intere5t? 11 rn
on remtl is tliRerent than that o/ appGCant uMicate bebw:
r�� �r �� a �,v�u �ue�
AEtlress of mortgagce w contraG se�er (num6er ertl sfraeS ury, sfafi. aM
Name of assignee or oiha owror.
aaaress ot assgnea (�umAe�
DOeS applifant awn P�P�;
���,� ���> r
DeEuction approved'c� tlre au.._
20 20
Signahrte d Camb Audiror
/�p� q��� c
�e,�y�
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Caunty
someone
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Remrtl
indeMedness �mpaid as d Is Ihe aP�t Me sde
legal a equitade o�vnefl
❑ Yes ❑ No
han spouse. iMkate wfth whom
Is Ihe C�PenY in 7uestian: MmuM Assesse0
❑ R� a�o�ny p an,�y a�a
r� rro� nc s
Nas this dedurlian been reGUesletl m P�P�Y
tw wrrent yeaR � �
20 _
Oate (moNh. daY, Y��
20 _
I/ We certify uMer ihe penalty of perjury that the ahove anA foregoing infomialion is W e and mrrect and that the applirant is a resident of Indiana aM
Qwner I contrad buyer of the aforementioned property on date applicatlon is filed.
]n re lo�mels hAryme) Date (narAh. deY. Y�h
slate. entlZlPootle)
Pei,on aufM�¢ed Ey d�Ay ezecuteC Power dAanneY or M I
AdCress M authoraed persa� (numberaM sbee; dry, state,