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.►`.�"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
`,, . : • ? FOR DEDUCTION FROM ASSESSED VALUATION y--� � � �
S�ate Fortn 43709 (RB / 2-07) �—�
°�; � Prescribed by Depanment of Local Govemment Finance g
INSTRUCTIONS: MAR ��6 �B�
To be filed in person or by mail wdh the CountyAuditor o/the county where the property is located. -
Filing Dates: 1) Real Property.' Dunng the 72 months befae June 11 0/ the year the deducG�on is to be eReclive. ��.,, �
2) Mobile Homes assessed under IC 6-1.1-7: Beriveen January 15 and March 2 0/ the yea� Ure deduc6on is2�maal��
See 2verse side la additional insWCtions and quali(cations. r � a
• p1950N COUNTY AUD170R
Applicant (owne d b r- ee reverse tle
T"rg i'a Key number i legal desaiplbn Rewitl num Page umber
- S-lOa-oo3. -oa� ���
Pssessetl value of 2al propary d March 1, airenl year Mortga�nVad irMebtedness unpaitl as of March 1, Is the applicant the sda legal a equitade ameR
airten � ^
v ❑Yes ❑ No
�, whai is his I her e�cad share of interesl? If o.med wNi someone olher Ihan spouse, indicale wiN whom.
name m recortl is tlMeren� Ihan Ihat
ame of nqrtgagee or conUacl seller
mortgagee or mnUact seller (num6er aM sfree(. dty. state. and ZIP rode)
Name of assignee w o1F�ar owner rn hdder of mortgage
Addrass of assignee
Daes applicant oan propetty in arry oNet
cwmy in Indiana?
❑ Yes ❑ No
Deduction app�oved in the amount of:
20 _
I/We
Indian
sta(e.
! .-/��� �J,R-�.,�"
��0 $ � a �S�
�,r.toi Y��Qk /S� 4u�.G G
oF applicanl (numbei 9atl streef. cdy. sfele. arM
of Al�omey a 6y IC G7.1-12-.07
Address of aulhwaed persm (namber end sfreei. aty. stafe.
Whal Temng �isirict?
20 I 20
Is �he praperty in question:
❑ Rral Pmperty ❑ Mobile Hrnrie (IC 61.
Has Iha deducfion been requested on propar�y
Tor niRenl yrafl
❑ Yes ❑ No
20 � 20
Counry Date rtanN, tlay, yee�
3 �o(� -D
going infortnaGOn is true and cortect and that Ne applicants was I were a resident of
0