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.r"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (128 / 2-07)
�' � Presrnbed by OePertmenl d Lacal Go�emma4 Firiance
INSTRUCTIONS: � � � � W i� ,
To be filed rn person or by maB wifh fhe CountyAuditor of the cou�y where the piopert y is located. ��
Fding Dates: 7) Real Property: Dunng Ure 12 months be%re June 17 W the year Ure deduction is fo be eBective.
2) Mobile Homes assessed urMer IC E1.1-7: Behveen January 75 and Maich 2 07 Me year the deductim is to be effective. .
See 2verse side /w additionel inshuctions arr8 qualifications. MAY 1 2 �Q9
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reme m recatl is d'AferaM Nan 1hffi of epplicanL �cate 6elovr.
Name af mortgagea or w�Vad sellar
Address of mortgagee a mntract
Name
streeC rity, siafe, aM
or hdder of martgage
>/ —Q�4� 3/ S -O ��
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Ir owt�ed wdh wrtieme aiher Iha
�
�� �a
spouse,
❑Yes ❑ No
Is Ihe poperly in quaslion:
❑ Real Property ❑ Moble Home QC Gt.
Address of assgnee (rxrtMer aM sUee(, dry. 9ate, aM LP wde) ' -'
Does applicarq wm PropertY in airy olher If yes. what county? Wh✓ —" vs de0udian
�������, a � 3 � �,���
❑Yes ❑No � ��
,= � C` �O O. .••' �
DeductionaPPmved'm�heamamtoE .Di�"' � —
p� �_ �_ caYa�o, ..
I I We c$rtify under penalry of
Indiana and owner fhe aiweme
�
�� o� �
❑ Yes ❑ No
�
Mat ihe above and roregoing in(ortnation is true and mrtect and that tlie appficants was / were a resiHenl of
P�Y on March 1, 20 _
Date (mmth. daY. Y��1
end s6eet, a11(
d by
Adtlress ot aWnr¢eA persan (num6eraM stre�, c2y sfata, aM LP code)
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