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n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun sh p
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• $tate Form 43709 (R71 / 609)
�' P�euribed N' �epaNereM af loral Govamrtmnt F�(ce
Ae a
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditw or Counry Recorder o/ Ne county where tAe property is located. F
Fitirg Dates: 7) Real Property: Must file during the year for which fha deduction is sought
2) MobAe /Manulactured Homes not assessed as Real Propelly Mus! fJe dunng the twelve (12) months GI SO O� OR
6efore March 37 ot each year the deduclion is saght County Recordu
See reverse side /ar additional inshuctions arM qualfications.
MP�nt (o trad bN'ar - see m,�aversa sidei. /i _ /1
Ass�seC value d mal pfapeny at d
MazU 7, p�rt yPar
1
if ro, what 5 his I her era�x sliare of intrlest?
If �ne on remd 5 Q`(fe2nt Uun Nat af appl
_ _ - v �Uvv, � —c�d // �
Mortpage/ Canvati'udebtetlness unpaitl az d Mortgage / CortVarl'v�deMeEness impaitl as d b Ne appfxant tlre sok
Me� t. curtent yeer Eate of app&ation / kgal a equiraHe ow'in11
(p ❑ Yes ❑ No
If avmed with mrt�eone othar than spouse. indinte with whom
�t uMicate Gelow. Is ProPertY in Question: MnuaP/ASSessed
� Rea� �o�ny ❑ tw,�,�nya� -
Name of rnortga9ee or mntrad se�ler
� 1
Mdress W mort9a9� or mntracl u0er (number nd y6
V
Name nf assignee or oNer ovmer or halder of mortgaga
AEdrea of asagnce (number antl atreet, rdy, slafi, antl
Does ePplimnl ovm praperty in any dher
taunrymintlana? I"1 .,__ I"I .�_
DeEuctlon
20 � 20
crty, stata,
If yes, xfiat
i y�
�i[�7�11i�I9
tar
Zo— zo NaR�Ea,�ce �o� Y
Sig�ature d Coimty AuEitor
I/ We ceroy unCer Ne penatty oi perjury that the above and foregdng ir, ' I �(„/' /
owner I contraq buyer of the afrnementioned property on date applicatlo
! u'(/�sidem atld`ass W eppfxant (numDer ana sLee4 �: s+a1z, a
l�? 0 3 /7 i.� � e� a°..�Oc.� OZ
Pe�son autha¢etl Oy didy ezew[etl Porer MAtmmcy w q IC G
Mtlress af aulhomctl person (numberaM sbeat. dry. sfata, aM
�
oate (monN, tlai: N
��ea o� v�Y
Yes ❑ No
20 _
i�
t of IMiana ard
A
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