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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou s Year
: FOR DEDUCTION FROM ASSESSED VALUATION
:I �-� .� State Fortn 43709 (R71 / 6-09)
�' ,,,, 1 Presaibed M Departmem of Local Gwemment Frence C .
de Mark
INSTRUCTIONS: or�.�i
To be filed in person w by mail wifh tAe CountyAuditor or Counry Recorder ot the counry where the property is located� F,�3 ��
Filirg Dates: 1 J Real Pmperty: Must file darirg the year /or which the deducLOn is soughf. Coun AuCimr
2) Mo6ile / Manufactumd Homes not assessed as Real Property Must file dunng the hveNe (72�g1(�.� CO NT Uf1ITp R
befo�a March 37 ot eacA year the deduction is saqht. County Remrder
See reverse side furadtlitronal insWC7nons arM qualificatbns.
MWmm( raconrractbuyer-see mreverseside) , a n
� L.iQ � •
Taaig Oi Key number / legal tlesaiption Rem�tl number Page numbu
ti-a -tio�-a-�o �5' -Ga a�
Assesse�.' rahre d mal WuP�Y as o! Mortpape / Contra� irWebtadn�s unPeid as d MwuNeGe / Conract'vNebtedness unoaid az of Is tlre eP�� ihe sob
Ma�Gi 1, a��eN year
II no. whal's ha / her e�1 share o
It name on 2mN is tlilferent Nan U
name of mon�asee «mnvact sener /!�T
l �G(
�
Address W nartgagee u contrace se0er (number e sn
Name of "`:T ee or oNei owner or hdder of rtartgage
Address of assignce (num0er aM stree4 �'N: s1sfi, and
f:a7��:n5
DeLUdion approved'c� Mre amount oF.
�Bade ownrYl
Yes n No
mmeo� other Ihan spouu, iMirate wBh whom
Is Ihe property in QuesGOn: Mmulty Asussed
❑ Real Property ❑ Mnually Aser,ed
enon�� rro� nc ��.
ee4 �y. sta�. aM ZIP wde)
LP coCe)
If yes. what munt�? VYhat Tarirg Distrirl?
COUNTYAUDROR �
20 _ � 20 � 20 � 20 � 20
Nas Ns tledurdon Eeen reGUesteO m pmperty
far arrent year+ ❑ Yes ❑ I
20 � 20
�riature ot CounbAUGimr I Couny I Date (rtanth. tlay.Yea�
I/ W certify urWer Ne penalty of perjury that Ihe above and foregoing in(ortnalion is We and corre<Y arW that the applinnt is a resident of Indiana and
owr�r' contracf buyer of the a�reF%Mioned property on date apPlication is filed.
owne/s h� name) .. Date (nrnCi. daY. Y�A
���n�`-'V• UICJ `(n//tLqS/'r%V/YJandZlApp
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Person auNOrized by duty esecuted Power ol Attorney or by IC 61.1-i2-0.7
MCress o( auNw'vEd person (number arM sbee; dry, state, and LP cotle)
(mnnN, tlaY. Y��