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ti� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ - FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fortn 43709 (R71 / 6-09) '
�' ` Presaibed by �eparvnent of Local Govemment Fnarce
� File Mark
INSTRUCTIONS: �
To be filed in person a by mail wdh the CountyAuditor or Counry RecoNer ot the county where the property is located. F� fl
Fi/ng Dafes: 7) Real Property: Mus[ fi7e during Ne year for which the deductan is sought � v '�r
2) Mobde / Manufactured Homes rrot assessed as Real Pmperty Must fi/e dunng the hveHe (72) months
befora Maich 31 0/ eacA year Ihe deduclion is sotght. ❑ County R er
\
Seereversesidefaadditaonalinswctivnsa�iqualrfications. � , NTYAUDITOR
1 rahc d rral @uP�Y � �
aaienl year
tt m,
Name of rtnrtyagee « oonvarl senu
Hddress of rtnrtgagce v oDntracl seA
Name of asvgnee or oNrJ owner or 1
Does applirant wm property in any oNer
oounry in IMiana? ❑ Yes
D�uc6on appmved'c� Cie amount oF.
20 20
numbu
�ol—V/' /i/O'W/
Mortqag w� � tetlnps unpaid az o(
A1amh 1
u�dirate Eelmr.
cdy, state. aM ZIP cotle)
If yes. Miat munt)/.+
❑ No
�
�
ritade o.me!?
Yes ❑ No
Is properry in Questian: Mnua�y Assessed
[�Real PropertY Q Mnually Pssessed
What Ta�dn9 D'¢trict7
zo �S""'_—_ `JUG�-y
- �a-yi��
I I We certify under ihe penalty of perjury that the above arW foregoing infc
ovmer I mntracl buyer of the aforemen0oned property on date appl' tion
�' owierslu➢na ) c Date
Fadl �asidem a0dress W appGcant� 6erantl sbee4 d, stafe, e P ootle)
�i93'T E sR6
Person auftn�veC Dy tluty executed Power W Attwney or Oy IC 61.7-72-0.7 Date
AEdmss of aWiortre0 persan (num0er eM sbeeL �: sbfe, an0 LP ootle) .
Eeen re9uesce0 on pmpelty I
❑ Yes ❑ No
20 _
��
=_nt o( Indiana arM
r�, day, yea�
rNli.daY.Y�� �