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"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ _ FOR DEDUCTION FROM ASSESSED VALUATION
.. . � Stata Fortn 43709 (R11 /6-09)
S 1 p��pyd p�, pe��n� of Local Govemrtrent Fnance
F a
INSTRUCTIONS:
To 6e filed in person or by mail wifh the CountyAudiror or County Remrder of the aounry where the property is locateds E P
FiNrg Dates: 7) Real Property: Must file during the yea� for which the deducfion is sought.
2) Mobile /Manufectured Homes not assessed as Real Property: Must file dunng the tweNe (12) months�
betore March 31 o/each yearNe deduction is sought. �- ���
See �everse side for additional instructnons and qualifications.
A�Gcant(owirerww�nfredbuyer.se�e5�ictionsm`eversesife) . . _ _ l �
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martn �. anrl¢Y� I hiarr�n �, ament yea
tt ro, whal is his / 1� exaG share of interest7
tt twre on rem�tl'a dAfemnt Nan Ihat W appOCant, trWirate Dehw.
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Addren of rtnrt9a9� or mntrad se�er (num6rl and stree; rdy, sYdte, e
Nama o1 assignee w other ovmer or hdder at mortgage
Ad ress pf assignee (number entl atree4 �1: sfele. B/d ZIP CoOe)
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Oces epplitant vm pmperty in any other If yes, what mu
JO. � !o! -Do
i as N Mwigage I Con�
date of app�catioiy
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rco�a�;mx -
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RecoN numbel
Counry Auditor
6ounN Recorder
Page numCu
Yes LI No
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Card NO . .......: .........:...
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VJhaI Taprg D"sU&Y? Has Uis tletluclian Eeen reVU�ted m P�Y