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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u s vear
__._ , FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (R71 / 609)
�' u» � Presmbed by Departmern of Laral Govemme�ri Finarcx
wsrRUCnoNS: UEC 2 8 g��a`�`
To be filed in person or by mail witA the CountyAuditor or Counry Rerorder o/ the counry where the property is located. F� �� ��
FiRng Dates: 7) Real Property: Must file durirg Ne yrearlor which the deduction is sought Coun Auditor
2J Mo6Re / Manufadured Homes ipt aacssed as Real Prt�perty Musf file during the twelve (12J ��"`i �� ry
before Alaich 37 of each r Ne deduclion is ht G g �u nry Recorder
� � GI950W COUtJ 'I Fw ITOF
See 2verse side for addilional instructions arM qualifications.
� Appfrcant (ymer ortontraC 6uyer- see resLirl;onspn rei.xrse side)
_ __• . _. __..._' . ____ �_
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MatG� 1. arrent
1
If no, what is tus / her e�1 share of intem_st?
If nart�e m rcmtl a CtRerent Nan Nat o( appOCant, InEip[e belmr
Name of mortBa9ee or crnvaU se9er
„--.:�: -,_�
�a�o,�
Does aPplicsm wm property in any ahef
county in InOiana?
❑ Yes
t3l��it]
I I We certify ur�i the penatty of
owner I contract buyer of the afon
-,30�-000. a�S-o a�
trarY indrbtednass unoaid as d Mortvaoe / Cano-
Is Ne appfi`ant the sde
legal w equitade ame/1
❑ Yes ❑ No
tt awned with someone other than spouse. indinte wtth whom
Is Ihe property in question: Mnuelly AssesseE
❑ Real ProPenY � ��!�Y �
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,�amw�cmr.�m MLPcode) I2•a8-doo n
����a FE,�tU�, S�Pu� �
��r�y, state. aM LP coQe)
�cr 3 5 3i ��5�(0 (�501`—° ��3/aoio
If yes. what county7 ' /N� t / /i � /7M �/Cll /�}
❑ No Ri /��C
aw,o�e �j a,y �ew:ea row�r
20
)UNTYAUDROR
20 20
Caunry
�_
Date (month. tlaY.Y��
� P�Y
n�
�
that Ne above and foregoing infortnalion is We and cortect and that Me applinnt is a resident o( Indiana aM
ned property on date appliration is filed.
Date (monfi. daY. Y�a�
by IC 61.
Ad025s o( authortre� person (number antl saeet ary. s+ate.
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