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"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS. n 7 hi Year
__, ; FOR DEDUCTION FROM ASSESSED VALUATION
. . State Fortn 43709 (R71 / fr09)
,' w. � P�eSmbed Dy DepaNr�ent o( Lazl Govemment FiflafrR
F
wsrRUCnoNS:
Fam fded whh:
To be filed in person or 6y mail with the CountyAud'rtw or Counry Recortler of the county where the property is located.`7�>
Filing Dates: 1 J Real Property: Must file durirg the year fir whiclr the deductlon is wught. �` unry Auditor
2J Mo6Re /Manulactured Homes rrot assessed as Real Property: Must h7e dunng the tweNe (12) ��N C U1� A��{ecorder
before Maich 37 of each year the deducfion is sought.
See reverse side (w additiona/ inshucGOns and qualificatrons.
District
popeny as m
i as of Mortgage / Contrart'uMebteCr�s unpaiE as al Is Ne eppilfant Ne sde
date o( appGtation legal ar eQuitade ameR
❑ Yes ❑ No
1/ ovmed wiM someorre other ihan spouse. indipte wtth whom
If name on 2md a EilfeRnl than that o! aPP�^L ��� �low. Is the prope`ty in 0���^: A^nualty Assessed
❑ Real Properry ❑ MnuallyAssessed
Name oi mortgagee or mntract seller
Address of rtwrtgag� w mntract seller (numbe� arM streel, fi1y, sbte.
stree4 �Y. �te. aM Z/P code)
Ooes aPNit2ni own pfopeM1y in any oNer I( yes. what munt�/.� What Taprg District? Has Ui5 Ce�u�on Ocen reQUeSteC on property I
muMyinlndana? ❑ No farartentyeaR � Ye5 ❑ No
❑ Yes