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.1 "•* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,,.: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R8/ 2-07)
°�;- •� Presaibed by Depanment of Local Govemmenl Finance
ie a
INSTRUCT/ONS:
To be filed in person or by mail wdh the CountyAuditor o/ the county where the propedy is located. � �E C 1 9 Z��$
Filing Dates: 1J Real Property: Dunng the 12 months be/we June 17 0l the year the deducGOn is to be eflecUve.
2) Mobile Homes assessed undei lC 64.1-7: Befween January 75 and March 2 0l fhe year the dedutUon is to be eRec6ve.
See reverse side /w addi6onal instructrons and qualifications. �'Jj6� ��
Key number / legal
Assessed value of real property as of March 1, cunent y�r
F�..'�-'yl
Name of rtqrtga9ee or contract seller
Address of mortgagee w wnUad eeller (rum6er aM sLeef.
a
�� � J-��'-/0/-C�l /7a �6
nVacl indeWedness unpaitl as of March 1, Is lhe
a�3000
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��-�7.� ,���ry,
D��������- �o..
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C81'(1 �0. .�y1"'..; • �
'�a13, D00 °� ,��zo' �'e'`° `
someone olher than spouse.
What Texing District7
COUNTYAUDROR
Is �he pn
❑ Real
AUDITOR
number Page mber
,�7 �
e sae i�ai «ey�uaa w,nen
❑Yes ❑ No
❑ Mobile Home
Has lhis dedutlim 6aen requested on poperty
for arrenl yeaf�
❑Yes ❑ No
20 C91 20 _ 20 _ 2b 20 20 _ 20 _
P
�raWre ry d Counry Oale (mo th,�ay, y�el� _ 0�
� � ��
I/ We certy unde lhe penal ot perjury that e above and foregoing information is true and correct and that the applicants was / were a resident of
Indiana and owner of the aforementioned property on March 7, 20
�rawr (owne/s fidl nemeJ Date (month. daY. Yee�
�
re enl atldress of applicanl (num er and street. cify. state, aM ZIP code)
� RC'`�S C.cec°k Dc;�e �t �i can�L, i t.l �I7(9LI`�
rcson aulhor¢etl by duy execvted Power of Attomey w by IC 61.1-12-.07 Date (month. day, yea�
peram (num6er aM sbeeC aty. sIffie. end ZIP wtle)