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.►°'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T s p Year
ry, _. ? FOR DEDUCTION FROM ASSESSED VALUATION •
� Stale Form 43709 (R8 i 2-07)
';y„ •� Presaibed by Depanment of Local Govemmenl Finance D E C 2 20�8
File Mark
INSTRUCTIONS: '�y�
To be filed in person or by mail wRh the CountyAuditor o/the county where the property is located. � p'�t+� .��
Fding Dates: 1) Real Properfy: Dunng the 12 months before June if o7the year tAe deduction is to be eRective. C/
2J Mobile Homes assessed under IC G7.7-7: Behveen January 15 and March 2 0/ the year ��bbil�f,erR�idTb� 6be@�T�@R
See 2verse side /or addiG'onal instructions arM qualificafions.
buyer-
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Asussed 1 e af real property s of March 1, airenl year Martgage / ConiraG indeWedriess unpaitl as of March 1, Is �he applicant Ihe sole legal w equitable o.meR
curtent year � 3 O O O ❑ Yes ❑ No
�, what is his / her exacl share of interest? If owned with someone other lhan spouu, indicate with whom.
reme on
rtartgagee or conUacl
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Address of mortg wnVact seller (n ber arM Sreef. tity. sfafe. anO ZIP
Nartre of assignee a dher owner w hdder of martgage
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Adtlress of assignee (number arM sfreel, city, state, aM ZIP cotle)
own property m eny olner
ia1
❑Yes ❑ No
Deduction approved in the amount
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Si9naWre ai Caunry AuAiinr
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If yes, whal counry7
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Wlul Tar
couNrvAUOROi
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Is the property in Question:
❑ Real Property ❑ Mobile
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Date (monN, tley, yeeA
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❑ No
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I I We certfy under lhe penalty of perjury that the above and foregoing infwmabon is We and cortect and that C�e applicants was / were a resident of
Indiana and owner of fhe aforementioned property on March 1, 20
i^84K6 (owne/s lull nqme) n Date (mon(h. daY• Y�A
cdy. s(ate. aiM ZIP I)�
7(w?P Yl��l L
aulhonzed by duly execuled Power of N�aney or by IC G7.1-
person (numberarMStreetdty.stafe.aMZlPoose)
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