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.� ^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
;, . � FOR DEDUCTION FROM ASSESSED VALUATION
. � � State Fortn 43709 (RB / 2-07) '
�°�;:,� � Presaibed by Department of Local Govemment Finance
File Mark
INSTRUCTIONS: DEC 1 � ZOOH
To 6e filed in person or by mail with the CounfyAuditor o/ fhe county where fhe property is bcated. �
Filing Dates: 7) Real Pioperty: Dunng the 72 months be/ore June 17 0/ the year the deducfion is fo be etFecfive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year fhe deducG'oai�j,%o be��.
See reverse side /a addi6onal insWctions and quali(cations. �� Q�(a �
side)
Key
rdue of real popaty as af MarU 1. ament ymr I Mw�gage /(
M g
artenlyear
If rama on recwd is drf(erent Ihan �hal ot applicant, indinte below:
Name of mortga9ee or conVact seller
Address of mortgagee ar mnlract seller
owrrer or
(number and sGeel. city, stafe. and Z/P code)
Dces appicarn oxn property in arry olhm
counry in Indare?
❑Yes ❑ No
� 00�.5�1.,��
D►•a���cr NO.�.....
�a►d NO. ..�.�.�..%.a�'do
�� �
aM ZIP coAe)
couNrr
zo
/ � C/
March 1.
w
�� I ❑Yes ❑ No
If amed with someone dher lhan spouse, indicate wi�h whom.
Is poperryinquesUon:
Real Property ❑ Mobile Hwr�e (IC 61.1
�
Has this deduction been reques�ed on proparty
fw arteM year+
❑Yes ❑ No
zo _ � zo _
day, yee�
I I We certify under lhe penalty of perjury that the above and foregoing infortnation is We and correct and that the applicants was I were a resident of
Indiana and owner of fhe aforemenCOned property on March 1, 20
)nature (owne/s 1 neme) / Date (month, tley, yea�
`�.�' � - r�.�:
resitleM address of applicaril (nw
515 5 � ,-bson 57
Person aulhonzed by Cuty execuled P�
freet. city. stete. aM ZIP cnde)
��«yo., i,v Y767o
lomav w bv IC G7.142-.07
Atltlress of aWhor¢etl persm (num6er antl sVeel vty. state. aM ZlP code)