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.r�'^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r,... = FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RB / 2-07)
°�; '� Presoibed by Departmenl of Local Govemmenl Finance
INSTRUCTIONS:
To be filed in person or by mail wdh the CountyAuditor o/ fhe county where the pmpedy is located.
Filing Dates: 1J Real Property: During the 72 months belore June 17 0/ the year fhe deduc6on is to be e/tecuve.
2J Mobile Homes assessed under IC 6-1 J-7: Behveen January 15 end March 2 0/ the year the deduc6d19A�6 � s�+��9
See reverse side la additional instructions a� quali(cations.
Appicam (owna tia dryer-see re '" s reverse side) ��!`
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qJ G1B5
Tab sUiq Key number / I al descri R nlT�
- � _�a �
hssessed value of real poperty as of Mairh 1, aaren year Mortgage / Conirad i�e6ledrress unpaid as of A/arch 1, Is Ihe app6pn sde legal w equitade ownen
artent year
If ro, whal is his I her ezacl share of irrierest?
�
..�dme on record is d'rfFerenl Ihan �hal of applicant, indira6 e .
Name of mortgage r mnUaq seller d
. - -�._-P.L-7—R=!
Address of rtwM1gagee w mnira�i seiler (numbe f, tity, sfafe,
Name ot assignce or oUer owner w holder of mwtgage
Atltlress of assignee (number arM street, city, sfate. aM ZIP code)
Does applicant axn propeRy in any ather If yes, wl�ffi co
cauiriy in Indana7
❑Yes � No
0
❑ Yes ❑ No
someone dher ihan spouse, indicate wi�h whom.
Is tha property in quesUon:
❑ Real Prooertv ❑ Mobile Home (IC 61.1
COUNTYAUDROR
Deduction apprwed in the amount of:
2b �_ ZO _ 20 20 _ 20 _ . - - �- �
P LL�A -��f
Sig�WreafCOUnryAUtlilot Counry � "'�-�
I! We certry under the penalry of perjury that the above and fwegoing intomiation is W e an D� �'/[��
Indiana and owner of Ne aforemenfioned property on March 7, 20 �
14n1 addres a icant (num er enL( s cdy. faf . a ZIP �
� � � � /> �
uihor¢ y duty exewted aver M Ntnmey a by IC G7.1-12.07
of aulha'sed persm (num6ei aM sVeeC dty. sfele. arrd ZIP co0e)
requested on paperty
❑ Yes ❑ No
Zo
ere a residenl of
C��,Arr 5� -
Date (monfh. daY.Y��