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""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7 shi Year
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
y„ Presaibetl by DepartmeN oi LoCel GOVemrtcenl FiIlBlxe �
File Mark
INSTRUCTIONS: � E `
To be filed in person or by mail with fhe CountyAuditw or County Recorder of fhe county wAe2 Ihe property is locat
Fiiing Dates: 7) Real Pmperty: Must file dunrg the year for which fha detludion is sougAt � County Auditor
2J Mobife / Manufactured Homes rwt assessed as Real Property Must fiie dunng the tweNe (12) months
6efore March 37 of each year the deduc0w, is sought �6 /.�winty Recortler
SeereversesideloraddifionelinstrtictlonsarMqualifications. f:IRSON COUNTY A �
Pij� ICe�/rnunbu/kgaltlAcdicrion Rewiarwmbrl
a!o-�a-OS- 30/-00. . y3 �-aa-8
ed �2hre d mal popeny as of Abrtpaq e/ Contraa indehtednass unpa'si as N Morlgage / Cm�act trMebteOrress �mG� az d
1. anm[ I� Mamh 1. ae�ent Y� _ Eate of aVP��
1113f 6 116 / hH C12d SI1N9 O( IIIIYl85Yi
: m remd is QAlerent lhan Ihat W aCW
otmort9a9eeormltradSeAer �
AAdress o1 rtnrtgagce w mntred se0er (nwriber end strae; cily. sts�, arM ZlP code)
Name af a"�nee or other ovmer w hdder of rturtgage
stete, and
Deduclirn approveO In Me amount of.
� aN
yes, what counp?
�— I �— I �— � zo
�� ea� wc�,ya,e�r� �
�2
I/ we certfy urWe e penalry ot
owner I contracl buyer ot the aton
Si9 (a�mershdneme)
FuU' ent addres. W appGCant (numGe
S- C(�9
Peison authomeE Ey duty ezewted Pow
AOdmss of authw'¢ed person (number a
SORICOIIG G}1Bf Ih3lI SpOlLSC.
WtmtTabrg D'¢tric[?
Ne above and foregc�ing infortnation is We an
property on date applicalion is filed.
state,
crty, state, and ZIP code)
numb�
Yes L� No
Is Ne O�De+�Y in qunsbon: MnuaM Psusse0
�Rea� PmpeRY Q NmuallY AssesSed
Mobile Fbrtie (IC 6
� ��7 �
r� ma aea� o� rea��a o� v�r
for artem Y�! � Yes ❑ I
a °/o_
Dra���cr \0 ...................
Card 10. ....���d.......
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