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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-W )
� w. Presvibetl by DePa�M o! Lxal GovemmeM Fwnce
INSTRUCTIONS: ' or���
To be filed in person w 6y mail with the CounryAuditw or Cowry RecoNer ot the county where the property is located. � M 0 Y� Q Z(] j �
Filing Dates: 1 J Real Pmperty: Must hle durrng the year /or which Ne deduction is soughG L� Counry Auditnr
2) Mo6de / Manutactured Homes rat assessed as Real Prtyierty: Musf fiJe during fhe twelve (12) monfhs
6efae Ma�cA 31 of each year the deduction is sought. � Coun Recorder
See /eversa side Ior additional insWCUons and qualificafions. �
'�,npyiwmSo�rnerarcontprtbuyyr-seeys�icoonsmje.eises+tle) • AUDITOR
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Sh2tB Oi YI}PlPSl?
-�b'- 6 3 —�lb.��'a-o� ?l oio ��.�
ge / Cantrati irde6teEness unpaid as d MoRgage I Contru3 irMebicdness �mpaU as d Is the app8rant Ihe mle
1. artent yea Eate M appG�ation /�/ � kgal � Uade �
�� Yes No
If wmad wiM mmeorre aU�er ihan soouse. irM'�fa with wlran
m remrd is CiRerent Nan Mat af appOrent hdinte Delo`�'.
Narre of mxtgagee a mnttaU seUer
Pddreu of mort9a9� � mntraU
owner w halder of mortgage
�t �: sisre, era z�a code�
Does a�m own property in any aNer
cwnrymindiana? ❑ Yes
Deaurrian appfovad 4� tice artnum aY.
20 _ 20 _
Sigreture of CamtyAWimr
�Isp�/� property in 0uestian: MnueM Assessed
L�Q Rra� PfopertY ❑ Mnual�YAs�ed
Dra���cr \O.s�.P.1.�.-.....
CBC� \O. ..�.•%•.j0.�.......
If yes. what munt�? I W�at Taritg [
io
GOUNTYAUDROR
20 _ 20 20 _ 20 20 _
Counry �— rDate (nanth. CaY. l'��
I I We certi(y u�der the penatty of perjury that the above and foregoing infortnation is true and correct ark that the appli[�nt is a resident of IrMiana ard
owner / wntract buyer of ihe afaementloned property on date appl&ation is fileG. -
mat�e T�mers hN namel Date (rtwnN. daY. Y��
uq� ( tity, state. antl LP cp
/f�e l�- ;ncP_�c
ora�«�,er � cy ic ��.�-iz-0.�
ACdress of auNa'rsetl person (num0er aM sbeet �Y. sm�.
oa�e (mw,m, ear. r�A