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.�-�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS_'. ip Year
r,.. FOR DEDUCTION FROM ASSESSED VALUATION
S�ateFarm43709(RB/2-07) M�.,�i� 2 Z��9
�� ' ' Presaibed by Department oF Local Govemment Finaixe
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INSTRUCTIONS:
To 6elled in person orbymai/ wifb fhe CountyAuditor o7fhe courrty where the propertyis bceted. r�qc ON COUNTY AUDITOR
Filing Dates: 7J Real Property: Dunng the 72 months be/ore June 11 o/the year fhe deducUon is to be efleL�t�v6
2) Mobile Hwnes assessed undar IC 6-7. 7-7: 8efween January 75 and March 2 0/ the year Ure deduction is to be eNective.
See reverse side !a additronal inst�uctions arM qualificafions.
COUNTYAUDROR
Deduction approved in lhe amount
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Sigrelure of CounryAudilnr
Courrty � Date (m�anN. daY• Y��
I I We certiry under the penalty of perjury that the above and foregoing intortnation is W e and cortect and that the applicants was I were a resident of
Indiana and owner of the afwementioned property on March 1, 20
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revdenl address of a icant (num6e� en0 sVeef. crty. sta(e. aM ZIP aode)
exewted Power of Ntomey oi by IC 61.
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