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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R11 / 6W)
�' y» Presvibed Ey DePartment ollncal Govemment Fu�anca . 1
wsrRUCno,vs:
To be filed in person w by mail wiM Me CountyAutlitor w Counry Recorder o! the counry where the pioperry is located.
Fitirg Dates: i) Real Prope`ty: Must file durrrg the year for which the tleducLOn is sought.
2J Mo6de / Manulactured Homes rrot assessed as Real Property: Must fJe dunrg Ne fwelve (72) rtwnfhsA
6efore Maich 31 of each year the deduclion is mught.
See 2verse side lor addifional insWCtlons a� qualificatbns. �
��., .,�n������Lf�„ . �i� � �.,/l � GI96QN
1.���'-.ul
If m, wha[ k his / ha eraU share of infe�est'!
tl�rne on remN's dAfemnt than ihat of applkan4 InElrate Eebw
Name W rt�atgagee or mntraa selier
Pddtess of nart9a9� or contrad sea
Nan,e of assignee or othe. awner or n
a ��a
,-
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Y�
PdC�s ot av9gnea (num6e� aM streeL mY. �. anALP coAe)
Does eppticent rnm property in any oNer If yes. what
couNymlrW�iana? f'i ..__ f-I .�_
a- o00
iess unpaid as �
Y`/l�at
o� - oa a
6 ❑ 'L 6'�d"h nuaimr
❑ County Remrder
naaci intlebtedn ss un0aid as d Is Ne app�ant the sda
31{m� 1eg31 a epuitade owneYl
�C/ � Yes ❑ No
dher than spouse. 4d'�te with wtwm
�Is e property in question: Mnualty Assessed
Real ProPenY Q ��!aM � . . .
_ a�4
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- D�� �pa`. .
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zo_ zo_ zo_ zo_ 20. _ zo_ zo_
sig�aw,e w camm nwitwr county oate (monm, ear, r�e
I 1 We certfy under Ne penalty of perjury that the ahove and foregoing infortnaGOn is We and cortec[ arM �hat Me applinnt is a resident of IrMiana arW
axner! mntraG buyer ot the afaementiated property an date applkation is filed.
sig ��an,r� (owrrer: h,u �l /� _ v / . , oate {mw,m. dar, r�n
PeJSOn autlra¢eE Oy Mdy e:ew[etl PwP+o(Attcrtiey a Cy IC 61.7-12-0.) - , I Date (mmN. daY. Y��) - -
Pddr¢s of aNhomEd person (number aM sbeeL �: sta(e. antl LP mtle) .