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^•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
>_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fartn 43709 (R71 / 6-09)
S hw 1 Prewibed by Departmen� O( Lxal GOVemment Firante
File Mark
ISTRUCT70NS:
m 6e filed in person w by mail with the CountyAUditor or Counry Recoider o� the county where fhe pmperty is bcated� �� 'H
Filing Dates: 1) Real Pioperty: Must file during the year Por which Ne tleducfion is sought. t ��
2J Mo6i7e /Manufactured Homes rat assessed as Real PropeAy Must fiIe during the twelve (72) months Gq
before March 37 of each yea� Ne deduclion is swght. U L I.� S[VfYY R�b�
UII
See reverse siCe for addifional instrucUons and quali�icatrons.
AvP��t(owne�armry�cjbN'z�•see eLShkDO/�SOpreverseside) �r " '
� /7Y �.J C �.e[/JT) �
wssessed raWe oF � prapeny as
Ma�tli 1. fimsG year
If no. what Is his! hu exaU slwe
If name on rtmtl is drtferent Nan that o1 avG�^�• cd"uate Eebw.
���,
«ca,aad sen
iher omrer w h
stare,
ol assk,y�ee (number antl street �: s+ate, antl Z/P ootle)
,���r.o...ao�.l.......
Dra �a
3 ...
Card I��� I 0�1,OOO.d�
IDaes app6nrit own poperty in any oNp I If yes, whal munry? I What Tari`g District? I Has Ihk deduGion Deen requested m propary I
counry in Ind'aria? ❑ Yes ❑ No for artent yna(.� ❑ Ye5 ❑ No