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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
__ , FOR DEDUCTION FROM ASSESSED VALUATION
. � Stata Fartn 43709 (Rit / 6-09)
�' ,�,� � PrewiCetl by �ePa�nl 01 Loral Govemmerit Fu�ance
�g1-�, F e a
�VSTRUCTIONS: �N'1
b 6e fiied in person w by mail wiN the CountyAudhw w Counry Recorder o( the oounty whe2 fhe property �s foca .
Frling Oates: 1) Real Properry: Must �le dunig fhe year for which the deduction is soughf. nty AuditDr
2) Mo6de / Manufactured Homes not assessed as Real Property Must file dunng the tweHe (12) m� 9 � Z �n R���
before March 37 0( e/ach year the deduction is saghG �'
See reverse � foraddifiQnal instr�rttbn�nd qualfications. ^ C.�.�'�-�
App5cam r,b{pmfia 4 m reverse siie) _ %� � � %� / n �
Assessed va4�e d real PapenY as d
A7a�N 1, amnt ymr
tt no, what a his I her exaa sha�e o
If name on �ecord "a dAfem�t Ihan tl
Name of mortgagea or cmtract seller
Piltlres of mr�agce a contraa se0
Name of assignee w other owner or F
�Y � , �� d�,�
�`�- a 1 c�
Ma(qage / Contraci "v
MarCh 7. W rteM yeer
.�7�.�
u�dica� Gebv.'.
V �
M siree; ciry, sfete, aM ZIP code)
AEO�ess ot assyrree (numDer aM streeG �ty, s�are, ana uv caoe)
Dces applinnt ovm pmperty in any other If yes. what muntyt
munry in InOiana? ❑ Yes
❑ No
�u.-.�.��� �.
i�
20 � 2b
I/ We certify under Ne penalry of perjuY� that Ne above a
owner I mntracl buyer of �he afwemen0oned property on
�qaNre (ownef: !utl rame) _
W
COUNTY Al
full revdent addmss W app�want (number an0 sLeet, rity, state, and ZIP m0e)
�2/96 .� st S�r/� �C..� GY �•
Person autlra�d Oy duh/ ezecutetl Pawer of Attomey or by IC 61.1-12-0.7
Pdtlress of aNhuaed persm (num0er arM sbeet, tiry, state, and ZIP mde)
>e' rv-'•T�
N COUNTY AUDi i �n
, ��,�.I P���E
eEeDtedness �m0� as of LS Me ePP�t Ne sde
tegal a ew�mde owneR
❑ Yes ❑ No
tlun spasse. irdifate wilh �Nnm
15 Ihe P�Ve+b in 9uestion: Mnua�y Assessed
�O� I� I 1" / l.1/
��� � 5� o ��
m
� No
20 _ _
��nry .�� I �� ( / �Y�an / /—
ig informalion is true and mrtecl and that Ne applitan[ is a resident of Irdiana aM
alion is filetl.
Dare (rtrnN. daY. Y��)
oa�e (�mrn, aar. r�