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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Form 43709 (R70 /i1-08)
� � P�ewihetlEyOeparbnen�dLaWGovemmeNFinar�
INSTRUCTiONS: � $ �I0 M�c , �
To be filed in person or 6y med witlr the CountyAWifa d U�e county where fhe poperty is bcated. A-i
Filiry Dates: 7J Real Property: Must fde dunng fhe yeer (or whhfi the deduction is soughG 1�✓
2) Mobde / Manu/acfured Homes not assessed as Real P/operty: Must file dunrig tlie tweNe (12) mon 6efwa MarcA 31 0l each yea�
u�e d��;o� �5 �«,�'�. MAY 2 7 2009
See /everse siae ia adddional insWd"ans and qualificafions
mreracl6�yar - mo ryrsbif�fians m �ow.m
MMh i. wrRttl year
0
tl ro, wha� is his / her e�tl share d iNera51?
If nama m recnd is dMeram Ihan that of appGrant. iMirata bebw.
mMgagee m m�hap se0ar
�mroapee
r�,r:�
Address of asipnea (ivvmbor and sbeel. dll: sfam. aM LP mdo)
5:Z
( Is Ihe app6raN Ihe ule
lepal w eQU�able a�nreR
❑ Yes ❑ No
wMan
�e D�vaM in Cuesiim: AnnuaM Assessed
Real Pmperty ❑ MnualyAssessed
DOes aPpliant oxn poperiy in arry olher HyeS. )�,� ) !{�(/�/��I �'---/j�� "�^^•his dBdudian heen repuesteE on prt�pBrty
camtymlMhana7 � Yes ❑ No ����[Jl✓ !{LAY-/( D/'1L-�i 1��� ❑ Yes ❑ No
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u..,a�wW �,�,na,,,T„�,..
zoQ zo zo. �/39 D�'`3/l(p,cl' zo zo
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I/ We cartify under Ihe penalry o( perjury ihat the above and (wegoing mtortnation is Wa and corred and tha[ the appiiwnt is a resi0ent of IMiana aM
owner / mntrad Wyer of the aforementioned pioperty on date aDP��n is filed.
7nat�owrrers f��anre) _ /1 Date (rt�orW+, tlaY. Y��)
ezetvlBd Power d Atlomay or by IC 6-1.1.12-0.7
person (num0erantlstrcel. aty, stafe. antl
Data (nqiXA. day Yeai)