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^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship vear
__ _ s FOR DEDUCTION FROM ASSESSED VALUATION
� n State Form 43709 (R71 / 6-09)
� Presaibed M Departmer¢ ol Local GovemmeN F�nce
� � � Fil
INSTRUCTIONS:
To be h7ed in person w by mad with the CowtyAuditor or Counry Recorder of the counry whe�e the property is
Fdirg Dates: 1) Real PropeRy Must file durirg the year for which tlie deduction is soughL � �punty Auditor
2) 6efolree Marc � o each yexr the dedeuction is sough���: Mus! fife dunng the hvelve (12) months O� 2�i'y�o �2unty Recorder
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See reverse side for additbnal instnrctions errd qualifications. !. �,,,� ._,.,—
Ta�drg ti trvt Key ni
o a
Ass¢sedvaNedrnalpaperty of
A1afU t, anenl yrar
aU
�ilq. W�Id� 6�16 � i12f BXdf� S�1dI8 Of YIiPfC5l7
tt rwre m fecad'n Ei1FeRnt Man Nat W app[�
Name of mmpa9ea or contraU se9er �
Mdress of rturtnaGee or contrarl se�er (ntun
A-pr(/qa�f-lX- 30� -
Aard�1, /COntraGinde6te7rress
artentyear
Name W assi�ee w oNe1 owner or holder of mtttgage
3
iu2nt Own
IMiana?
GR7
Dedudim approred'o� Ure amouni oE
uty, sta7e. arM LP cade)
20 _ � 2� _ � 20 _
I/ We certify under the penalty o( �Erjury that
o�yrf€rTConuaq buyltr of y�e atoremerrtioned
^J
O. 49lc-vo
asW MortgagelContrarY
tlate of aoo�cafion
�f OW11Bd
COUN7YAUUROR
kpal weWitaWe wmeYt
U O ❑ Yes ❑ No
wuse. iMimte witli whom
�I-s-i�h°e �pra�peny in Vuestim: MmiaOYAssesuU
q_i..�� RoPertY ❑ lvmual�YAssessed
caoK, o�Q Y �. e - - —_
l a-so� i�o
20_ � 20_
Caunty
20 _
Date (month. daY• l'��
�
e arW (oregoing infortnalion is We and cortM and fhal Ne applirant is a resident of Iridiana aM
on date appliration is filed.
Date (monfh. daY. Y��
Pddrew o( auNU¢ed person (numbera� sbee4 �+N. ��. � LP cade)
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