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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n ip Year
� FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fwm 43709 (R71 / 6-09)
1,�,. ` Prcsm6ed by Departrtierd ol Local GovemmeN Firence
F e ark
INSTRUCTIONS:
To 6e lled in person w by mail with Ne CountyAuditor or Counry Recorde� o/ Ne tounty where Ihe pmperty is locat .�. F�
Filirg Dates: 1) Real Property: Must file tlurirg the year /or which the deduction is sought. � Counb Audimr
2) Mobde / Manufactured Homes rat assessed as Real Property Must f+le d�n�g the hvelve (1��f eO NT � ��70R
6efore March 31 of each year the deduction is sought ounry Remrdu
See reversa snde foi �itional insMictions and qualifications.
I Appfrant (owrer or buyer - see resbic8'wit pyeye��side�
I.I1 D '�N //(J1al �SA9-033��/OO•il5-D�9
mal pfoperty as d Abrtgage / Contract irdehtedness unpaid as of Mortgaga / Contrad inEeMedness unpaN az d Is Ne applirant Me sde
ar Marti� 1, arrent year date of aPP�� kgal or equeade ame/!
❑ Yes ❑ No
�re
tll
Name of moftgagee or contraU 5eqer
ar mntraa se�er (nwMar end sLaeR cdy. statr.{�nd LP cadej
Name of assignee or oNer owner or hdEer of nwrtgage
(numDerad snee; cdy, slete, and
eny
IS IM P�PenY Ifl CUCSOIXI: Af111Ud0Y ASSPSSCQ
❑ Real Pioperty ❑ Armuany PsseSSed
MoWle Hort�e OC fr7.
What Ta�dfg District? I Has �his Eedurlim Ceen reQU�ted m pmpelty
for artent yea(.� �__ �.