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^'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_, � FOR DEDUCTION FROM ASSESSED VALUATION
� Slale Fortn 43709 (R71 / 6-09)
�' Presfribed by DepartmeM of Local Govemment Freme
w` File Mark
INSTRUCTIONS:
F U
To 6e filed in person oi 6y mail with the CountyAuditor or County Recorder o/ the county whe2 Ihe property is located.
Filing Dates: 1) Real Properry: Must fi/e dunng fhe year Por which tha deduclion is sought. C� ry��o�nty qud"rtnr
2J Mo6i/e / Manulactured Homes not assessed as Real Property: Must file during the tweAre (12J months !C"�
befora March 31 of each year Ute dedudion is sought. ❑ County Rvcorder
SeereversesidelwadditionalinsWCGOnsarMqualficaCans. GIB .,,. �vurvi Huul OR
App6rant(owre�atantppfbuye�-seemsbiU�'onsory)Oers�J'da) . _
yopttty es ol
M, Wh91 LS h6I h¢f Cl2d ShBIB Oi Iflf¢f¢Sl?
0 � C/
/ ContraG intle6letl�s unpaid es of Mongage / Conirac
vrtent yenr date of appti '
N awned vrith someo�fe oUer
If rwne m remd is tliRerent ttan ihat ot a0p�^t, uMirate bebw.
Address W morc9a9ce or cantract
ownerorhdderotrrongage
(numberentl streeG �riy. slate, aMZ/PCOde)
Dces applimnl ovm property in any oNer
counryinlM'vna? I-1 ..__
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Tadng Disvirl?
Page
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unpaitl as d Is t�e applrc'ant the sok
1/ legal w eQUitade wmM
i� ❑ Yes ❑ NO
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�PQRY ❑
Na dedudim Eeen reQuestetl m propesty
urtemY�R r-i .. r-�
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