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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C s p Year
FOR DEDUCTION FROM ASSESSED VALUATION
StateFnm43709(R10/17-08) MAY 8 2009
� � Rasaibed by DepaMren� d Local GovemmaM Firence
INSTRUCnoNS: F/lle �Mark
To be filed in permn w by mad with the GountyAWitor of the county where the poperty is lacated. �%a� �v /',ix�
Ftiling �ates: iJ Real Property: Musf file tluring the year /w whidr the tleduction is sought. ��
2J Mobde / MarnAactureC Homes nU assesse0 es Reel PropeAy: Must file dunrg Me IweNe (l01B9QJt$ �K�1`c/pgy411(� year
the deduction is spyhl.
See reverse side 7a adddanal instnidions and 4ualifm,ations
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Y m, what o his I her erxf share of
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ar oont�aU seAer
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�e number
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Yes ❑ No
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❑ Real Proparty ❑ Mnualyl�ssesseE
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