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"'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court
__ _= FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 43709 (R71 / 6-09)
,�u. Presaibe0 M��n of Lxal GoremrtieN Finance
INSTRUCTIONS:
b be �i ed in person or 6y mad with Me CountyAUditw or Counry Recorder o/ the counry wheie fhe property is located.
R7irrg Dates: i) Real Pmperty: Must file during tfre year (or whirh !he detluction is sought
2) Mobde /Manu(actured Homes not assessed as Real Property Must fiie durirg the twelve (72J months
6e/ore March 37 o7each yearthe deduction is saght.
See reverse side 7or additional insfructions and qualfic�fions.
�/�_/�_ .SD ``- ODo
Mortpape/ Cantraa iMehtednass unpaid a
Mart3ii wrtentynar
6
If rwne m �emN is OiRer�t Nan ihat of appOmnt, uM'uate Dabw
Name of rtnrtgagee w mntrarl seller
s�:e.
Mtlress of asignee (number aM slree4 ary. s+ete, antl LP catle)
Oces appCrent am pmperty in any oNU If yes, what
�,� � ��a�a
❑ Yes ❑ No
[�j Oc�n,Q,��a,e�m�
❑ Counry Recorder
GIBSUrv t�vu
Remfd mimDv
S�O- Od� �,
�9a9e / ConraU iMeMedness imv�d as d
AUDITOR
J, (�„LJ I U�Yes LJ No
SpOU50. �K'31C Wlb1 WIINfI
�IsI{pe property in Guestion: M�uaDY Assessetl
IEI Real PmPerlY ❑ Mnually A�e�ed _._
Dra»er NO.. �Ib........
Card NO. .....��� `........
�r�y sso.�
� � P�Y
Yes ❑ No
� � � � _ �_
inawre U CamN Auditar Counry Date (mavh. daY. Y��)
I I We certify urWer the penalty of perjury that Ne above and foregoing intortnation is true and corteG arM Nat Me applirant is a resident o( IMiana aM
awner I mntract buyer oF the aforemenboned Property on date application is filed.
�tan�re�ox�rrerS fiA reme) ^ /l Date (rtmN. dal: Ysa� ..
Pert.on auNOraed Cy OWY esearted PoGvJ of AuaneY w by IC 61.
Address o( a� person (numberaiM street crty, sfate, eM Z
ZIP
Date (rnmtn. Efi: lea�
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