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.� "^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
�.:, _= FOR DEDUCTION FROM ASSESSED VALUATION T� �
Stale Form 43709 (RB I 2-07) �
�' - � Presmbed by Departmenl of local Go�emment Firiarxz
de Mark
�NSrnucrioNS: AUG �6 Z008
To be �led in person o�by mai7 with the CountyAuditor of fhe county wbere the property is located.
Fding Dates: 1) Real Properfy: During the tt months before June 17 0l the year the deduc6on is to be eflec6ve.
2) Mobile Hanes assessed under IC 61.7-7: Befween January 15 and Ma2h 2 of the year the deducGon is7�p;�g eBe�v�
See reverse side la addifional instructions a� quali�cations. v�"`�'}j
wmnLad buyer-
T' g DisUicl �, � �Key num5er I legal description RecorA number Paga number
�- - a- ao-000. s _o�.� � 3s
Assessed value of real ryopgty as d Mardi 7, avrent y�r Morlgage I Conbaci i�ebteEness unpaid as of March t, Is Ihe applicant Iha sde legal a equitade owner+
�rt�� $ 3 QQ ❑Yes ❑ No
� what is his / ha exaq share of inieresl? If owned with someme W�er Ihan spouse, indicale wiN whom. '
If reme m record is differenl ihan Ihal of applicant, intliple belo.v: Is Ihe property in question:
❑ Real Pmperty ❑ Motple Horne (IC G7.
Name of naiwacee or mnUaU sellx w A — —�-- ._
Address of rtartgagee a oontrad seller (number an0 sf2et. dty. sfale. and
Name of assigriee ar olher owner or hdder of mortgage
Address of assignee (rxm6er aIM slreet,
Does applicani mvn property in arty ather I If yes, what caunry?
wunry in India�?
❑ Yes ❑ No
Oetluction approved in lhe amount of:
�,�.�. ��,-'�
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Si9naWre af Caunrylwdilor
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Drawer NO ................... �i
Card NO. .:5�/.:3..°,0, w
�e�...�( �/���C., o�w•�oC,
Ta�cing DisVi,.. ' '^-�
fM nirt¢nl yeaf/
❑ Yes ❑ No
COUNTYAUDROR
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Caun�y
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�ate
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I/ We certify under the penalry of perjury ihat the above anA foregoing infomiation is We and corred and that the applicanis was / were a resbent of
Indiana and owner of the aforemenuoned property on Mardi i, 20
�naWte(owne(sM1dinar�gj n _ n ' /.
Date (ma'th. day, yea�
address of applicant
' � 7 v+/I v.ev+�c/!i
Power o} AtlorrreY a by IC 61.142-.07
AdNess of aullnr¢etl pe�son (num6ei an0 s4eeG
I
Date (rtanfh, day. yea�