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ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R11 / 6-09)
� f Presaibed M �ePartmerd o1 Lod Govemment Fuaxe
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INSTRUCTIONS:
To be fJed in person w by mail wifh the CounryAuditor or Counry Recwder of the county where the property is located.
Fi1vg Dates: 1) Real Property: Must file dunrg the year for which fhe deduction is soughf.
2J Mobile / Manufectured Homes rrot assessed as Real Pmperty: Must fi7e dunng the fweNe (12) months
before March 31 0/ each year the deduction is sought.
See 2verse side for additional inshu4tions and qualr�cations.
�AooGrantf ncan7raC6wer-see mreve el A
Ai� � lega� aesaip .
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;¢d rahre o( 2al propary as ol hfongage / ContraG iMeDtetlness unpaid es W Moriga9e I Con9arS u
1. alferrt year Mart�h 7, artenl ye9r date of appl'KaGaj' .
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If name m rom�tl is Citfe2nt W n ttut af aPp�n; mtlx
Name at m�utgagee v mnbaG seller �/
Pdd2ss d nqrlpag� ar cantract seAU (num6er anl sq
Name of assignee a dMt or�wr or haldu af mortga�e
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�mpaid as d I h tne eG7�t Ne sok
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P�cen1' in aues�on: Mmially Assessed
�I Property ❑ Mnually Assessed
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ve and mrrect aM that ihe applir2nt is a resident of Iridiana aM
Data (monfi. OaY. Y��)
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