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^'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (R71 / b-09) �
� � Presmbed by DeP��rit o1 Locai Govemment Fitwxe
�«. �.
INSTRUCTIONS:
b be filed in person w by maii wiM the Co�ntyAuditor o� County Recorder o! the aounty where the property is located. F� �� � 2� �2
Fdirg Dates: 1) Real PropeRy: Must file dunng the year for which the deduction is soughG . � County Auditor
2J Mob�7e /Manuladured Homes rrot assessed as Real Property: Must file dunng fhe hvelve (72) months
6e(ore March 31 of each year the deduction rs soughG <�'. MCoun�' `YeC\ der
See reverse ' e lor addifional inshuctions and qualfica[ions.
srQ n. rrov.�'rv iinl'r R
AppGram( ctb rsee m2 �le ��l-��' . � ✓� LV
m6er! �desaiption
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It m. what
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m�emrd ia dittermt Nan Nat ot app6rant, Mdirate Eebw.
Name M rtnn9a9ea or mntract seAer L) �
Address of rrort9a9ee w contratl seDer
Name af assignee or other ovmer w MIGer ot rtartqage
and ZIP code)
��
r� ❑ No
wiM someone aher Ihan spouu. uWicate wilh whom
Is U�e ProPenY in question: MnuaDYASSessed
❑ R�i �oc�nr ❑ a,���y w�ssea
Does e�ykanl vim p(operty in eny othef 11 yes. whal munlyl Whal Tarirg D'avict7 F1as �h's AeOuction been repueste0 m p�opelq I
counry m IrM�ana? ❑ YCS ❑ No for artent yeaR ❑ Yes ❑ No
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