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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
;.�_..
: FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (Rfl 1609)
,• I Prewibetl Iry DePertrtrent af Loml Govemrtrent F�nce
INS7RUCTIONS:
To 6e filed in person or by mail with the County Auditor or Counry Recorde� o/ Ne county where the pioperty is located.
FrN�g Dates: 1) Real Pmperty: Must file dunng the year (or which fhe deduclion is soaghf.
2) Mo6ife /Manufactured Homes rpt assesced as Real Property Musf fife dunng fhe fwefve (72) monfhs
before Malch 37 of each year the deduction is sought.
See reverse side 70l addtional inshuctions and qualificafions.
Aod�nt(ownermmntrac►buver-saarest+irbwumreversesid . . _
- �-« -
vapie d p�operty es of MoRgage/ ContraG'uWek
,,amm,rx Mardy7�cyrte��
a �-i �i�
If m, what Is his / her ezact share o( interesl?
11 narne m remrd a CAlerent Nan that of aPP�^l �iwte bebw.
Name af rmtgagea n contraU uller
AddRSS of mortgagee w contract seller (number arM sb
Name of assignee or aNU owner w hdder ot fmrt�age
AAdress ot assignee (number aM slree4 �y. s+a.��- �
ciry,
-oa
�`'LUIU
Counry Auditor
C,qupq Recorder
unpaid as of is Ne appl'xanl tlfe sole
legal or eQURade o�me/!
❑ Yes ❑ No
someone otner tnan spouse. irait'ate wM wlwm
Is the property in puestion: Mnua%AsusuH
❑ Real Property ❑ Armualh/Asussed
Ooes apd�mnt am propnrry in any oNer ' I Nas Nis Cedur]im Ccen requeste0 on property
munry m Intlana? ❑ YES ❑ N I for wrtent `RaR
Dra���er 10...c%Q...........
❑ Yes ❑ No
Dr�uc6m apptoveC In ihe amount of.
CBCd �i0. ......�. �........
zo zo � n�a �� zo_ zo_
d
SignaMe o( Counry Autlitw ..,.,.���r Date (rtwRh. daY. Yee�)
��, 1/ We certify under ihe penalry of perjury that the ahove and (oregoing informalion is W e and mrtect arM Nat Ne applican[ is a resident of Indiare afM
owner / contracl buyer of Ne afo2mentioned property on date appliration is fiied.
I� re( Ys !u0 nartre) C(� . \'��"�_ Date (monih, daY. Y��)
\1
uthoraed Cy duy eiew:ed Power of Attomey rn 6y IC 61.1-12-0.7
ot auNw'vEE person (number a� sneef, cdy. state. an0 LP mde)