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;��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i' � FOR DEDUCTION FROM ASSESSED VALUATION o t n ip Year
�•. .,«.'y Stata Fortn 43709 (R6 / SO6)
� Presaibed by Depertment of Laal Govemment Finance ��N � 8
INSTRUCTIONS: �� ��ile Mark
To be filed in person or by mail with the County Audito� of the county where the property is /oc�SONC a
Filing Dates: 1) Real Property: DuAng the 12 months before June I1 0/ the year the deduction is to 6e e7t�ti�Y AUpIT09
2) Mobile Homes assessed under IC 6-1.1-7_ Belween January 15 and March 2 of the year the deduction is to be effecfive.
See reverse side /or additional instructions and qualifrcations.
Applicant
Taxing
contract buygr- see
Assessed value of real property as of
March 1, curcent year
Ii no, what is his / her exad share ot interesl?
on
number / legal description
11 lK- IU7� VVq. DVJ�Q I
Mortgage / Contrad indebtedness unpaid as of
March 1, current year
� ,.�.,,��. D 7
number �0 � �
or
If owned with someone other than spouse, indicate with whom.
If name on record is different than tliat of applicant, indicate below:
�me of mortgagee or contract selier �
f
Address of mortgagee or contrad seller (number and st2e ,'ty, state; ZIP
Name of assignee or other owrier or holder of mortgage
Address of assignee (number and st2et, city, state,
Does applipnt avn property in any other If yes, wh�
county in Indiana?
Deduction approved in the amount ot:
20 _�
P
Signature
20 �_ 20 9 Y
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�o�
�We certify under the penalty of peryury that the abo�
resident of Indiana and owner of the aforementionea
Signature (owners /ull name)
. �
� .',
Full res'v nt address applicant
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❑ Real
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❑ Mobile Hame QC 61.1-�
reques�ea on
' � Yes ❑ No
ias / were