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.r--"�•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
;, .. t FOR DEDUCTION FROM ASSESSED VALUATION
- Stafe Form 43709 (RB / 2-07) � �
�0�; � Piesaibed by Departmenl of Local Govemment Finance
u.
�rvsrnucr�oNS: DEC��� 9aC008
To be filed in person or by mail wdh the County Auditor W fhe county where the pmperty is located. -
Fding Dates: 7) Real PiopeRy: Dunng the 72 months 6efore June 11 0/ the year the deducL'on is to be eflective.
2) Mobile Homes assessed under IC 64J-7: Befween January 75 and Marob 2 0/ fhe year the deduc6on is to�e�ective��
See raverse side /w additional instruc6ons arrd qualifications. 0 a��/ N �
i 1 �� �riiiA�TV AUDITOR
Applicanl ( P/ w mnUadhuyer - see �e ..ans m reverse sjdey� ' _
ralue of mal popPriy as d
whal is his / her exact share
morlgagee or wniract seller
nymber / legal desaiption
� 3 - _ �p _
1, arrenl y�r Mortgage / Contrad ind
artentyear ,
Address o1 rtartgagee w mnUatl seller (number arM sheet dty, state.
Name af assignee a other o.vrrer or hdder
Address of assignee (num6er aM sVeel. �
Does applicanl aw+� property in arry dher
caunry in Intliana7
❑Yes ❑ No
Deduction apprwed in the amounl of:
20 �� 2b _
Signawre ol Counry Audilor
as of�March i.
someone
Page number
«ay��aa �
p(JYes ❑ No
spouse, indicala wi�h whom.
he property in Quwtion:
Real Property ❑ Mobile Home
Drawer NO:ai,.Q:O.if:.,�SG a
If yes. what counry7 VJhat Taxing Dis4 Card \T� . ............'...:.....
�,e{IM�WCc�z�r%/� %�`.�a
COUNTY AUDITOR �
20 _ 20 _ 20 20 20 _
Oate (monfh, tlay, yeaA
I I We ceAify under the penalry of perjury ihat ihe above and foregoing infortnation is We and correct and that tlie applicants was ! were a resident of
Indiana and owner of ihe aforemenfioned property on March 1, 20
�naW+E bwne/s hAI ne/me) �- Dale (monfh. EaY. Y��
l
Person
oi
by IC
parson (numbaraM sVeet cdy. slate.
1
day, yeaA
1