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.+� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T ip Year
T,, .: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R8 / 2-07) M R 1 6 2009
�°�„ •� Resaibetl by Oepartment of Local Govemment Finance
File Maric
INSTRUCTIONS: �
To be filed in person or by mail with the CountyAuditor o! the county where the propeRy is located. �
Fding Dates: 1J Real PropeAy: During the 72 months before June 77 0/ the year the deduction is to be effective. �rv�nt7v AUDITOR
2) Mobife Homes assessed under IC 61.1-7: Behveen January 75 and March 2 0/ the year the deduc����E1reCLV6.
See reverse side /or additional instructions and qualifications.
���I�
is
It name m recwtl is tlifferent Ihan ihal of applicant, intlirate below:
of mortgagee ar contract seller
rtwrlgagee or oonVact
��� m
asvgrree (number aM sheef, tity, sfate, en0 LP code)
Does applicant own poperty in arry olher
counry in Indiare?
❑Yes ❑ No
Deduction appioved in the amount of:
20�� 20 _
0
— i c.ti — c..vi . ;L,i � —u c
7e / ConUad indebled�ss unpaid as of March 1
year �7 .. _
antl
If yes, what munry7
Ca��
someme
number
Is Ihe appGmnl Ihe
❑Yes ❑No
Is Ihe proparty in quesYOn:
❑ Real Property ❑ Moble Hane QC 61.
Dra�ver NO..�`%•••••••••
Card NO. ..LL...�°1'..�'IO..........
VJhat Tadng District� (' (� `IY� '�'�C..IiJ. �/
� J.1..% .
COUNTY AUDtTOR
_Pi�
Couny
20 _ I 20
oa� (mmm, ear r�A
20
I/ We certify under lhe penalry oi perjury Uial fhe above and fwegoing infortnation is true and cortect and that the applicants was I were a resident of
Indiana and owner of ihe aforementioned property on March 7, 20 ___ ...
Person
ss of applicam (number antl sfreel. city. stale. a ZIP mOe)
3� 8 sv S �� ,('�,�.-: ��
by duty ez�culed Pow�{of Nbmey oyby IC 61 J42-.07
Atltlress of authori�}Q,yersan (num6era�M sVeeG city. sfate, aM ZlP oode)
Dale (month. day. yea�
reen