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.+°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
State F«m 43709 (RS / 2�7)
�' �✓ Presaibed by Department o1 Local Govemment Finance �
File a
INS7RUCTIONS:
To be (rled in person or by mad with the CountyAuditor o/ the county wheie the pioperty is located. Q U � � s Z� � i�
Fding Dates: 1J Real Property During the 12 montlis be(ore June 71 07 fhe year the deduction is to be e/fective. �
2) Mo6de Homes assessed under IC 6-1.1-7: Behveen Janvary 15 and March 2 0l fhe year fhe deduction is to 6e eAective.
See ieverse side for additional inshuctions and qualificafions. �� �Q�
m �everse si0e)
K�j mmi6er I legal desaiption Rem�d number Page number
� � -aa-o�/-�oo-oo0.0.�8-oa� 2-ao8 i��l
poperty as oF MarU� 1, ament y�r Morlqage / Corrtrad indebledness unpaid as of March 1, Is Ihe appfipnl ihe sde legal or equitaWe owneR
wrrmt year I,
s �U ❑Yes ❑No
his I her exaq share of
If reme m recnd
;t? If wrt�ed wNi someone dher ihan spouse. indicate with whom.
i�nle belrnr.
Name of mor�gagee or contracl seller C/ �
...l�
Address of moM1gagee u mntract seller (number aM AreeG
Name of assignee or ol}�er awner w holtler
Addr�s
ovm property in any other
a1
❑ Yes ❑ No
Deduction apprwed in Ihe amwnt of:
�
SyraWra
�
state, and ZIP mde)
If yes, whal
�3��
and Z/P ca0e)
0
Is lhe poperry in ques6m:
❑ Real Property ❑ Mobile Home (IC E7.
Dra�ti�er \'O.. °c��........
Card NO. ....��.�4�...........
`�o'Z5, oG0• °p�'
20
20
day,yea�
1 on poperty
�s ❑ No
20 _
I I We certify under the penalry of perjury Mat the above and foregoing infom�ation is We and mrted and Ihat the appGcants was I were a resident of
Indiana and owner of the aforementioned property on March 1, 20
Signature ers fuff namejJ � . Da�e (mmN. daY• Y��)
address af applicaM tnumber and sGee1 crty. sfate, a� ZIP mde)
wrized by duly exewleA Power of Attamey or by IC 61 1-12-.07
aulhor¢ed pe+son (number arM s4eal, oty, sla(e. aM ZIP code)
Date (monN. day, yea�