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°'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�., _ FOR DEDUCTION FROM ASSESSED VALUATION
S�ate Fortn 43709 (R8 / 2-07) �
�' � Presrnbed by Department W Loral Govemment Finance
File Mark
INS7RUCTIONS:
To be filed in person or by mad wAh the County Auditor o/ fhe county where the pmpedy is located. A PR 4 2 Q Q$
Fd'mg Dates: iJ Real Property Dunng the 12 months befare June 77 0! fhe year the deduction is to be eRective.
2) A4o6i(e Homes assessed under IC 6-7.1-7: Aehveen January 75 and March 2 0/ the year the deduction i�ct,nyyb�a eBec6v�
See reverse side fa addiLonal ins6uctions and qualil'�ations. /i't ��
Apqicant (�me cqrr6act quyer - see re4iicFiony�g r�qverse side) � ,� � , OR
Asseued rahie of re� propsly as d
ecacl share af iMerest?
recoid is d'rfFerent �han Inal of applicanl,
Y��
Name af mortgagee or mntracl seller ///�
��J �]
Adtlress of mortgagee w mniract seller (numbei an7 sy
U
Name ot assignee or other oaner w hdder of morigage
Address of assgnee (muMei end s6eeC �l: state, m�o
� O -U00.�-7d'-Dad' U
I CorNaU' ebcedriess unpaid as of Mart�h 1, Is the appGmnt Ihe sde legal or equitahie mmeft
ar
❑ Yes ❑ No
If owned wM someone ather Uan spouse, udicate wiN vrtrom.
Is Uie propeM1y in questlon:
❑ Real Property ❑ Mobile Home pC Gi.t
, n .
dN. sfate. aM LP crode)
� ry-"""'- - �M� �r%
— (nARr�, �B
CCg ���� �
Deduc
2 08- la�o
COUNTYAUDROR
20 I 20
Has Uds deductiu� been reques�ed on property
fw artent yPaR
❑Yes ❑No
2� 20
i�Wre of Caunry FwdAnr Counly Oate (monfh. day, yea�
I/ We certify under the penalty of perjury that the above and foregoing infortnation is We and correc[ and that the applirants was / were a resident o!
Indiana and owner of ihe afwementioned property on March 7, 20
n ' Date (montA, Oay, yea7
�naWre.(ownne�Ys7u0na�)... Y— :
�dtlent atldress oi�icani (num6eranditre 1. cdy. sfafe. arw
��il� � � e�l'�(����i�P�.
Person aWior¢etl by duly eneated Poxer of Altmiey a by IC G1.1
Adtlress ot aulhoraed psson (numberaMsbeet dty. sfafe. arM L
o� c�m.