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^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R77 / 609)
, u» � Resrnbed by DeparUrrenl of Lnml Govemment Fuiance
INSTRUCTIONS:
To 6e filed in person w by mail with the CounryAUditw w Counry Recorder o/ the tounty whe2 the pioperty is located.
F�7ing Dates: 7) Real Property Mus! (le durirg the yrear (or whifh the deduction is sough[.
2J Mobde / Manufactuied Homes rrot assessed as Real Property Must f+le during the hvelve (72J rtwnNs
6efora MarcJr 37 of each year Ne deduction is sought.
Year
Recorder
See reverse sida /or ad �� nal instrucfbns and qualificafions.
AppGwnt(ownerorcon ct m s�de) BI O�
�istrict numCer/I ald Remrtlnum P numDer
� - o-r�o. as � 3s
Asessed vaqc d rral qopMy as d Mortgage/ Cantracl intlebte0ness unpaid as ot Mortgage / ConvaC mtlehtetlnass unpaiE as d Is �he aPP��t Me sok
karM 1, qmN ypar Mamh t f°�"t,�°� /� date o( appGtation legal w eQUBade amrYl
1 "! _l / J��� n Yes � No
what's ha / her exac� sl�are ot interesYt
Ii (wne m remd is dMerent Uan thaf W aOP�. md'rate
„�, , ��
Addrea ot rtartgagee or contract sWer (numbrl arM streef, cdy, sta�. arN LP aode)
Name ol assignee w oth� owner or hdder ot morigage
AdCress of assignee (number arM stree4 �'. slate, and LP oode)
Does c
wunry
any oNer
vriN someo� othe� ttan spouse.
Is tt�e P�Pe+�Y in vurstion: Mrivalry Assrssed
❑ Real Property ❑ Mnually Assessed
MoWle Fipr�e OC 6
Tad(g District? I Has Na deduclion been reGUested on P�Y
ro� a�„c yean n., r-i