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"'na STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Co T" hin Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
�' � State Form 43709 (R11 / 6-09) `I �7
�'' � p��'p¢d by Departmenl of L.oml Government Fnance v CO ��
��� File Mark
INSTRUCTIONS: C'�'��"� "
To 6e fifed in person or 6y mai7 with the CountyAuditor or Coun Recorder of the coun where the ro Fortn med 4nTh: '
�Y tY P PeRY is located. R"
Fifing Dates: 7) Real Pmperty: Mus[ fi!e during the year (or which the deductlon is soughG (;I BSO CC�I fi'Cdkit� A�d�r
2) Mobiie / Manufactured Homes not assessed as Real Pioperty: Must file dunng the hvelve (12) mon(hs
before March 31 0/ eacA year the deduction is sought - ❑ Counry Recorder
See reverse side lor addtional instructions and qualifirations.
AnoGrant! orronfiart,bwu-seeresLirlions versevtlel ,. I, i /
�istriG Key rwmberllegal desc�iption � Remrtl numbel Page numDnf
` - �-o -��a-�os��i� oa� �a �
�eG vdlue of reai poperty as N Mortgage / ContraG 4iCebtedness unpaid as o( Mortgage I Contract mdebteEness id as W Is ihe app6�ant the soie
7. amrnt �ear Mar� 7. wrtem year date of aPPG�tion/� ��/�� legal O Yese Q No
If ro, what fs his ! her exad share of u
If name on recwd's dtlferent Nan Na
Name M mortnacee « mntract seller
of mortgagee w mntraG seller (nurrf6er aM stree4 �tll: stafi, and ZIP wde)
Name of assi9nre w oNer ovmer
ACtlress of asignee (number ana svee4 �Y, sfate,
someane
Is the propnrty in qursmn: Mnua%PSSessr.d
�Real Property ❑ Armually Assessed
Does ePPlimnt own propeM1y in any oNer If yes. what munt�? What Ta�dng DbtriG7 Has �his dedu�]im 6een requesteG on prop�ty I
munry in India�7 ❑ Yes ❑ No �r a�� �n ❑ Ye5 ❑ No
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