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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION ��
� State Fomi 43709 (R11/6O9)
�' ,w, ✓ PresaiheA by Departmenl af Local Govemmenl Fnance
File�M�rii
INSTRUCTIONS:
To 6e filed in person w by mail with the CountyAuditor or Counry Recorder of the county where the property is locafed. F���� 2��2
F7irg Dates: 1) Real PmpeRy: Must file during Ihe year for which the deduction is soughG � (�qunty Auditnr
2) Mo6ile /ManWactured Homes rrot assessed as Real Pioperty Must fiie dunng the twelve (f 2J monfhs -rj--„
6efo�e Maroh 310l each year the deduction is sought C��O' �°C �\ry �R \oorder
See2versesidePoradditi9nalinstrucfionsandqualifications. �,,,,,TV qnniT(1R
AcNvnt (owner w - see resLiflwif rn revetlasitlel �/� �—_ I
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armv year
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ane �+ �..('�� �
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MortvageN�baa� e6ted�s unP� as d Mongag �P�� inEebtetl'm_ss unpaid a d �
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uMicate bebw.
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Dat
mu
��=�a►a- ���y
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20
VJhat Ta�dig D'atricl?
20
sv�e. hia�te wtt
Ls tlie 7roG�Y m V�
❑ Real Propetty
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Yes LI No
Has ihis detlutlian Eeen re9uested on P�openY
ro, a,eren� veaR r-i .. r-� .
20_ , zo_
ICounry I Date (monlh. daY• Y��
going infortnalion is We and cortect arid that Ne applipnt is a resident of Indiana ard
�pliption is filed.
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