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. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Ye�,
_, FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (R70 H7-08)
�,.,. � Prestnbed by Department d Local GwemmeM Finanm
�NSrnucnoNS: Mqy 2 2��y�
To be lled in person or by mad wifh fhe CourMyAuQita d fhe county where the poperty is located.
Filing Dates: 1f Real P(operly: Must Re during fhe yeer for whitA Ne Oeduction is sought.
2J Mobde /ManWacture0 Homes not essessetl as Real Property: Must fi!e durirg Me lweNe (12J mo��e� 1 0/ eacfi yeer
the Ceduction is swght.
s� re�� �;ea areaar�o� �wa;w� e�d a�rm�eo�s G1380N Co nrtU ?� f;_ 6+�da
.1Tr ,CJ�ui/tic'1--+ — i — - —
AssesseC vdue d raal propefly as d Mort¢a¢e I CmiraU inde6teErress
Alarcn 7. mrera yea 61a� i. wrrem year �� 0 0
1�
Y ro, what is hs / her e� shara d iNe(asY!
H(anie m rarml is d'dferem uun thal or ayc�. "ud"pam bebw.
ar caeraa
Aderesa d rtonpapee or
Narna d assig(ree or oiher rnmer a holdm of mut9a9a
Address d�ipnee (num6er aM s6eef, dfy, sbfe, ad LP code)
OeduGion aVG�oved in 1he amouM of:
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Signature d CouMY Audilor
7 � � - �a
d as d Mortpape / Cmtraci indeM es
dale of 5qtion —
/
u ownea wu sa�rewre er uwi wousa.
couNTV Auo�roa
20 _ � 20 � 20 _
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caM Q�e sala
iitabla amen
Yes ❑ No
Is Me MwaM in Cuestim: NwuOy Assessed
�RealPmperty ❑MnuaOyAssessed
MoWe Fidne (IC 6
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UC:I\VCC N�........
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C, E-FC. � ��1�7CA.`9�
20 _ ( 20 _
I/ We certify under the penaity af perjury that ihe above and faegoing infortnalion is true antl cared ana that the a�wnt is a resitlent of InOiana aM
owner I mntraG Wyer af Me aforementione0 qoperty on te application is filed.
�nature hlnarrre)!� � ,�n � Qate(rtroNh.CaY•Y�)
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�`I F�A reSiQant adE s o( appticanl rumG�aM sbert. fily, sl
y1�` ��� � ���Ln//iT .%%
I �hrsm authmaetl W dWy esecvted Power af Atlomey or by
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Date (rmYn. daY• Y�)