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.�°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�_., .; FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R8l 2-07) �
's•� �' Respibed by DepaMment of Local Govemment Finarice
File Mark
INSTRUCTIONS: AUG I �J. ZOOH
To 6e filed in person or by mail wifh the County Auditor o/ fhe county where the property is lorated.
Fding Dates: 1 J Real Property: During the 12 months be(we June 11 0/ fhe yeai the deducEon is to be efiective.
2) Mobile Homes assessed under IC 64.1-7: Be(ween January 15 and Maich 2 0l the year the deduc6on-is�tp 6e elfestiyg.
See reverse side /or additional instr�ctions arrd quali�cations. Q�16� �3 A��
(owner or oonUacf
_ ���_" �-��-ca3.a��-o a�
artenl y�r Mortgage ! Con�a cl iMebtedness unpaitl as of March i.
ai`rent yea 4-/ /M l J�
�{f �.-1 � z 1
whal is his / her exacl shara of iMerest?
If `ame m record is difierenl lhan that at applicard, indirate beJar.
Name of rtartgagee or cmUaU
� �
of rtaM1gagee or mnVaC seller (nwnber aiM s6ee4 dty..Y'' N
\
Nartre af assigrree m other oarier m holder of
Atldress of assignee (mrtnbei and sVeet, cih
Daes appliwnl own ptoperty in any other
counry in Indare7
❑Yes ❑No
Oeduction appmved in the amount of:
�ri��
ReoorA number
�
is me �u�,� u�:we i�
someone other than spouu, indrate wiN whom.
� OO .•'��
:�������'a!��`��� ��
� .�ar°'��3� 9
�
...ain Dislnct?
Ca
COUNTY AUDITOR
\
zo _ � zo _ � zo
a equitade wme�
❑Yes ❑No
Is ihe propeM in queslion:
❑ Real Pmperty ❑ Mobile Home (IC 61.1
Has Utis deduclion been
forwrrenlyzaR -
20
uested on pmperty
❑ Ye5 o No
20
W re of nb J� �.Se/"1`1-i�.C.t�/ I Caunry I D� (i J�d�yl BJ' ��
I I e certi under penalry of perju iha[ Ne above and fwegoing infortnation is hve and correct and fhat tlie appGcanis vras I were a residenl of
Indiana and owner e aforementi property on March 1, 20
��a4ue.{awqgLefW(name) � Dale (maifh. daY. Y��)
�cJ
reside ess of applicanl (nvmber andstreet, cily. state, aM ZfPcode)
� joa> .S�a�e �1-/L���- ���„«foN s , �i��b>o
rson aulhorized by duy eneculed Pvaer of fLLtamay or by IC 61.1-12-.07 ' Dale (monfh. day, yoa�
Address of aNhoi¢ed person (num6er arM street d[y, sfate, a�