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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION onMpun - �7 w Year
��M� J State Form 43709 (RS / 4-03) ��
� Prescnbed by Department of Loral Govemment Finance
u 0 3 2006
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. �y,, `
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 0l the year the deduction is to be effecbve'6����
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of 1tie�€Ar tde dsGnc �tk1i}�3¢sibe eBective.
See reverse side for additional instiuctions and quali�cations.
Applicant
see
Assessed value ofrealproperty as of
March 1, current year
If no, what is his / her exact share of interesl?
.m
Key number / legal description
rUo -/ Jl •p 7 •�jp! _ oOd �S'/7-
o��-�,�sy �-� oa8
Mortgage / Contrect indebtedness
March 1, current year
7dQod
If name on record is different than that of applicant,
'me of moAgagee or contracl seller �/�
below:
as
Record number
Page number ��/�
f is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee ar conlrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
l) \e�
property in
❑ Mobile Home pC 61.1-�
Does applicant own property in any other I If yes, what counry? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaf?� Yes� No
Deduction approved in lhe amount oL
20 0 20�$_ 20
\ �
Signature
COUNTY AUDITOR
20
County Auditor
20
�
Date
20
certify under the penalty of-peryury that the above and foregoing information is true and corred and that lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
s full
�'
X.5a Y e. �„� � sE ,��,,,;_.�.,�, .= a 4 a. � �c,
Person authorized by duiy executed Power of
or by IC 6-1.1-12-.07
of authorized person