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.+°^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co r ear
� FOR DEDUCTION FROM ASSESSED VALUATION '
S1ate Form 43709 (R8 / 2-07)
�1 f Resmbed by Department af Lacal Govemment Finance 9 Z���
File Mark
INSTRUCTIONS: �� � �
To 6e filed in person w by mad with the CountyAuditor ol fhe county where the properly is loceted.
Fding Dates: i) Real Property: Dunng the 12 months before June 77 of the year tlre deduction is to be eflec6ve. TY AUDITOR
2) Mobile Homes assessed under IC 6JJ-7: 8ehveen January 75 and March 2 07 the year the deducSon�B�'��.
See 2verse side /a additional insbuctions and qualifitations.
Appl' nl (owner d o�on/(rd�d��j�J{ - see re ��ms on reverse sde) ,
Q�u-�'il�� /�� " i��<.Z�it.a-P�
Taang i'cl ey num ! legal desUiption Record numbrJ P fwmbu
�-1 -�-o?oo _ oo/. �s z-o d 7 aoo z �oo
qs,�.d r�ue of rnal popaty as d Mamh 1. arrenl year Matgage / Con12U indeMedrress unpaid as of March 1. Is Ihe appficant Ihe sale legal w equitaWa o.me/1
airrefn year Q D oO
❑Yes ❑ No
If�whyl is his / her ezact share af in�erest? If owned wiU� sort�eone dher lhan spouse. indicale wiih whom.
If reme m record is diRerent Ihan U�al af applipnt, indirale below: Is �he property in ques�m:
❑ Real Property ❑ Mobile Home QC Gi.t
Nartre of rtpr�gagee or conUaG
Address of rtwrlgagea w owiUaC seller (n�mber aiM 3reel, tity, state, and
Name of assignee u aU�er rnrirer w hdder af morigage
Address d assignee (romNe� aH slieet
Does applicant wm propeny in any other
county in Ind'ana?
❑Yes ❑No
Deduction approved in the amwnt of:
� �
SignaWre of Caunrylw0ilor
ZIP mde)
If yes, whal counry? W
COUNTYAI
� I �
CWNy
xrty
Drawer NOS?7.SQ.°% ,- �'b �jy ] r,o
Card NO . . . . ..............
Va�
I/ We certify under the penalty of perjury ihat the above and foregoing infwmation is we and rorrect and that tlie applicanis was / were a resident of
Indiana and owner of the afwementioned property on March 7, 20
...��.,.e �,,,.,,.e�� nar.a..a� Date (monlh, daY• Y��)
(numberanC
auUia¢ed
ofaulho�rzedpersm� (numberarMShee4
�y. stafe. arM ZIP oo0e)
t��-C� �
or by IC 61.1-12-.07
state, arM ZIP oode)
oa�e