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^'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__, • FOR DEDUCTION FROM ASSESSED VALUATION
:• Stata Form 43709 (R71 / 609)
S f PresaiEed Cy �epartmeM of Laol GovemrtreM Fi`wrx
�STRUCTIONS:
Fc
To 6e filed in person a by mail with the CountyAUditor or Counry Recorder of the county where the property is located.
Fifing Dates: 7) Real Pmperty: Must fiJe dunng fhe }rear /or which the deducfion is sought.
2) Mo6de / Manufectured Homes irot assessed as Real Property Must fi/e dunng fhe tweHe (72) months
6efore March 37 0/ each year the ded�cGOn is sought.
See reverse side for add�itional instruclions arM qualifications.
qp (mmer or - see resnictiara m reverse side) SO
T Oistrict Keynum6er/legaldesaiption Record�u
�1-�,,,, �� i �_ n n _ - p . -p
������� I�
mM 1. ane�v yaa 1
no. wfial Is �a I lcet erar2 share Ot Nterest?
nyn¢ m remrE 5 Aifie�ell� Nan tltat ol appliranl
Name ot rtartBaBee a amaari
Address of rtartgagce or canU'
Name oi assignee a other awn
mmtgage
N asm)nea (numoer am suee; cay, s�xe,
difaM own property in any ahu
����� ❑ Yes ❑ No
orauc0on apwwea m u�e amwm
�. / Contraa'udebcetl�ss unpaid as d Martgage / Contrari mEehtedness unPaid as
tu�renl Y� f i. _w+� date of eDO��
ciN. �ffi, en0 LP mda)
�ountfi� uQimr
Countv Remder
couNry
Yes ❑ No
sPODU. �ntl�rafe wM wrom
Is Me P�M in qunsUOn: Mnua%h.sesud
❑ Rea� Propertv ❑ lumua .M.As�ed
(?�,�. �Q (.'a�1
d' ��-� (� � s a�a�a� c�,
enl yeaR
D�-�383
� w�r
❑ No
20 20 ' 20 _ 20 _ 20 _ 20 _ 20 _
Sigrenrte d CounN Aud'aor Caunry Date irtontlr, daY. Yea�
I/ We certify uMer the penalty of perjury that Ihe above and foregoing information is W e antl corteU arM that the applirant is a resident of I�iana and
owner I contraG buyrs of ihe aforementioned properry on date applicatbn is fiied.
SianaNre (aur�e(5 hN �me) _ I .-. i n Date (monfi, daY.�Yae� �
�ukresident aOtlrnss d appGCant (number ard sLeet, ary, sta�$!antl ZfP m
Pasm auUromeE Ey EWy ezea;ed Power af Attort�ey rn by IC G7.1-t2-0.7
P4dress of aWraaed persai (num6er aiM sbacG dty, sfafe, an0 ZIP code)
Date (lronfi. d3Y. YBe�