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.�* °"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION
� ' SUte Fartn 43709 (R8 / 2-07)
S r Presmbed by Departmenl of Local Govemmem Fir�ance
uw
File Mar1c
To 6e filed in person or by mad with the CountyAuditor of fhe courrty wheia the properfy is bcafed. � U N L 20 � 8
Fding Dates: 7) Real Pioperty: Dunng the 12 months belore June 11 0/ the year the deduction is to be eReclive.
2) Mobile Homes assessed under IC 6-t 1-7: Behveen January 15 and March 2 0( the year the deduc6on is to-�,eflecG�.�
See reverse side /or additional insWctions and quali(cations. O��o :1 �
C/
Appfic4nl(�merormMraC 6uyer-see 2fCr�6�f m reverse sde� � 9
of mal paperiy as d March 1. amenl y�r I Mohga9e /(
anren� year
exaa
reme m record is E'rf(erent Ihan Ihat af applican4 ��icate 6elow:
Name of mortgagee or miUaU sellel
AdAress of moM1gagae ar mnlracl
Nartre of assgnee a aha aw
Address of asvgrree (numbu
Dces appliraM own property i
caunry in Intliana7
❑ Ye
Deduction apptwed in ihe am
20 QQ_
state. arW Z!P code)
a hdder of mortgage
arq sUeet, cily, 9ate, aM ZIP mde)
� dl�SO,UES Tbm�ny _�
5 A�E,�A,J0�2� E
l �•�9y�
unpaid as of March 1,
med wi1H someone dher
mdng DisUicl?
OR
Is Ihe applipnt ihe sde legal
i��.c.:
spouse,
Real Property ❑ Mobile Home QC 61.
Has Ihis deduGm becn requesteG on property
fw aurent yeaR
❑ Yes ❑ No
20 I 20
Daie (monfh, day, yea�
20
I/ We cerfify under the penalry of perjury that the above and foregoing infortnation is true and mrred and that the applicants xas / were a residenl of
Indian and owner of the atwementioned property on March 1, ZO
imaen frnimah /WI rumel n /1 � � � . Da�e (nqnlh, daY Y��
/c�y_ sfa/t". an0 LP/ �mde) /L /�_�7 �—/ � C �
L Li /l� / ' / /'T . /—� �cI iiL%, �!�✓ —T � �
Perwn aWoraed by duty acewled Paver
person (num6er aM streel, aty. sfate, and LP mde)
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