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'���i�S� i�le I.�les
r STATE�JENT OF NORTGAGE OR CONTRACT INDEBTE�NESS
` FOR DEDUCTION FROM ASSESSED VALUATION
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State Fortn 43705 (R17 / 6-09)
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File a
To he fifed In person or by ma�. '
FilingDates: 1JRealPioperfy:�.Ius:becompletedanddatedlnfhecalenderyearfo�whichfhededucUon'lssovy�� � {� �
N,us: 6e filed wl;h the Coun.yAUditororGounty ftecorcero; ,n=oo�ntyWhere Ihe pmpeRy (s Ioca��SOn� 0 � itor � I
on or before ✓anvary 5 of fhe lmmedla,efy sueceeding caleaCzryear.
Z) Mob�7e /NanufaCured Homes nof assessed as P,eaf Proper;y: M,✓st Rr e wifh ;heCountyAudi;oro; the- Coun;y Recorde�
, .countywhe,�;heproperyfslocafeddudng[hetwelve(f2JmonJrsbeForeMairh3lofeachyeartl;e�
deduc6on is e�ugbL
See reverse s/de Poraddl(IonallnsWctrona A�d ��,�r,e�,u..,.� � � �
In Iha
20_ I 2G_ I 20_ ,20- I 2p- - -
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ccunry
I/ We cer'Jfy under the penal.y o; perjury that the above and foregoing info,�apon Is uve and correc: and that the 2ppfica ,t is a�resident of Indlana 2nd
owner! contract 6uyer of the aforementionad pmae ,ry on Ca;e applica;ion is filed. �
parson
of At;omay or
perso: (nv,r,berxndsVae�Gty,
code)
_---IL
(morlh, day, yea�