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�°•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
c�� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R8l 2�7)
''; '� Presaibed by Depanment of Local Govemment Finance
u.
File Mark
INSTRUCTIONS:
To be filed in person or by mail wRh the CountyAuditor o/ the county where the property is located. - Mp,R 2 4 2��9
Fding Dates: 1 J Real Property: Dunng the 72 months be/we June 11 of the year the deduction is to be eflecfive.
2) Mobile Homes assessed under IC 6-1.7-7: BeMreen Januery 15 and March 2 of the year the deduc6ar is to be eRec6ve.
See reverse side /or addifional instructions and qualificatrons. `�'jj„v ,Q�y
Applican wn wwnVa b�yer- see 2 - nons ,on/
� C.�
Tad �ct Key number I
value of property as of March 1, ament ye
,, wnal is nis � ner exac� snare m imerest7
If name on recottl is differenl �han �hat of applicant, indi
Name of mortgagea or conLact seller n i
1(O — CJ�/' UUJ. d� Clv 0
Mortgaga I CanUad indeWedness unpaitl as of March 1, Is iha applipnt �he sde legal w equilaMe ameY/
wnent year
� �Q, � ❑Yes ❑ No
If o.med wM mmmne dher Ihan spouse, �cate with whom.
Is ihe wWeM in puesUon:
❑ Real Pfoperty ❑ Mobile Home
�_�YJ_�v vv__�- _ __. - -
Address of rtwrtgagee or mnlra�t saller (numberarrd Sfreef, rity, state, aM LP.��� --'
Nartre af assignee a a�her axner rn hdder of mortpage \ O. I� � o(/ ��� �
.1// 4, �{•
Dl•a���er i' Y"
❑ Yes ❑ No
Detluction appmved in ihe amounl of:
20 20
Signature of Counry Autlitor
C •.•Q• • un baen r uested on
Ityes,whetcaunry7 .11-(j�0..�•••.••••.•• a eC WoPenY
/f �,���p �OO��� ❑Yes ❑No
�cJ�_
COUNTYAUDROR
20 20 20 20 20
I! We certify under the penally of perjury tliat the above and foregoing infortnation is We and correct and ihat the applicants was / were e resident of
Indiana and owner of the afwementioned property on March 1, 20
1Bm9eSowne/s hAI name) , /j . Date (mmfh. daY.Y�A
residenl
cdy. state. aM
af fLLtomey w by IC 61.1-12-.07
of aulhoraetl person (num6ei ar�d street city. s(ete.
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o�+e �mon�. eer. r�n
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