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.t-•�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
�,. ., � FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RB! 2-07)
��' �;: � Prescnbed by Departmenl of Local Govemment Firiance
INSTRUCTIONS:
To be filed in person or by marl wdh the CountyAuditor o/ the county where the propeRy is located. � MAR 2 7 2009
filing Dates: 1) Real Property: Dunng the 72 months be/ore June 11 o/the year the deductlon is fo be elfec6ve.
2J Mobile Hanes assessed undei IC 6-1.7-7: Befween January 75 and March 2 o/the year the deduclion is to be eflective.
See reverse side /w additional insWctions arM qualiFcations. �yr,� � r.
0 �� qi++1
Apqicant
see �es�Yions m reverse sieey
//ne r
value of real popaly as of March 1, urrnnl year
�r�ame on recortl is tlmerent Inan lnat ot
Name of mortgagee or contracl seller
Address af rtartgagee or conUacl seller (,
Name of assignee a aher owner rn hdd
Adtlress M assignee (number arM streef.
Daes applicant own poperty in atry olher
counry in Indiana7
❑ Yes ❑ No
Deduction apprwed in the amaunt of:
�
�
street. dry, sfafe.
aM ZIP ootle)
�oi- ood�� 9-oa �
/ ConUaG indeWadness unpaid as of March 1
someone
' IR�OG� IP��`�
Is the appGCant Ihe sde leqal w equifade ownel)
❑ Yes ❑ No
Is Ihe poperty in queslion:
0 Real Prooertv ❑ Mobile Home (IC 61.
If y Has Uus deducfion been requestetl on property
, . /�� � �� tor wnent yeal�
lll':11\'Ct' �iO `....�-.�.. aYes ❑No
C:ll'(� ��0. ......�............
; .P.�.�,,...,di' /�k �/, 7a�. o a
ca,�ry
zo_
Date (monN, Eay, yee�
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I I We certify under Ihe penalry oi perjury ihat ihe above and foregoing infortnation is W e and corred and thal the appli�ants was / were a residenl of
Indiana and owner of the atorementioned property on March 7, 20
�awre (ownelsluliname) _ Date (monfh, tlay, yea^
�esidenl address of applk
�ay. ���
Person aulhorized by tluty ex�
Atltlress of aulhorrzed persm
3nbk�4+aet. cdy. stafe. aM ZIP mde)
� . )T � ���1G�'hL:t'�
of Altomey a by IC G7.1-12-.07
� sVeeL aly. state. aM ZIP oode)