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""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__.. = FOR DEDUCTION FROM ASSESSED VALUATION
�• Stata Form 43709 (R11 / 6-09)
S,,,, % Presm2eC M �epartmen� o( Local Govemment Finance
INSTRUCTIONS: o�Ied, r�
To 6e filed in person o� by mail wiN the CountyAudifor or Counry Recwde� o/ Ne county where the property is located. S E P F ` LUU9
Filing Dates: 7J Real Property: Must file dunng fhe year lor which tha deduclion is sought � Cqunry Auditor
2) Mo6Ae / Manufactuied Homes not assessed as Real Property Must fiie dunng the fwelve (12) months
6efore Ma2h 37 ot each year the deduclion is sought ��yh L6'��nty Recorder
O'� r°'
See reverse side for adtlitional instrucdons end qualifications.
nt(ownerarm�trartbuyer-�s,eIe reversevde) •
T
Ta�drg Oistricl Key numEer / legal descriDUm Rem�d numDer Page numbrl
a6-�o-3�-aoo-oo�1. o�/v-o� 0 9 �98�
Asesed aFinal as d Martgage / Contrau'udehtedness unpaid as of Mongage / Cantraa'vMe6tedness unpaiE as of Is Ne appfirant Ihe sole
March i, year MerCh 7, a�rtent year tlate of appGca�im legal d equRade awne(.�
1 ��� n n n ❑�'es ❑ No
I(110. Whd16 h6 / hPl ¢idit Sh2!¢ 011(IIPRSi?
tt nartre m �emftl is Cilfereni Nan Nat of app�nl, indk
Name af mortgagce a mntrar3 sequ
S�_
Pdd2ss oi rtart9agee w contratl se0er (numbrJ end sn
Nama o1 assignee w othu awner or hdder of mortgage
AdCr�s ot assignee (number anC street �Y, s/efe. aM
Does a�ipnt rnm property in any oNer
munry in Ind'ana?
❑ Yes ❑ No
DeEUCion appmved in Ihe amoum ot
zo _ � zo � zo
I / We certrfy
ciry, stete, aM LP code)
wunq? �WhatTari�r,
zo
TT
Is the pfoperty in Quesnm: nnnuaM nssesseE
�Real Property ❑ Mnuallyl�sessed
DI'811'CI- 1�`�.. GY�9
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-�oa�e cmavn. ear. r��1
penalry of perjury t the above arW foregoing infwmalion is true and cortect aritl Nat Ne applinnt is a resident of Indiana arM
of ihe afaeme � ed property on date applicatlon is filed.
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Pert.on auNO(aed Ey Auty esecuted Fbv.er o( AttameY m
De�son
state. and LP mCe)
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