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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R71 / 6-W)
�' f Presaibed by �epartmenl of Lnfal Govemrtrent Friance
INSTRUCTIONS:
To be filed in person or by maB with the Co�ntyAuditor or Counry Recorder of Me oounty where the property is located.
Fdrrq Dafes: 7J Real Property: Must file dunrg the year for which fhe deducfion is sought.
2) Mo6i/e / Manufactured Homes not assessed as Real Property Mus! fiie dunng the fwelve (12) months
be(ore March 37 of each year fhe deduction is sought.
See reverse side lor addidonal instnedions arid qualifications.
I A7G� eshicLOns �n re�rrse sidel .
_„_,�_
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�1art3� 1, CurerM1 year
It m. what Is his I her e�tl
tt name m remd "a 6lferent Wn that af app6cant md'wate �ek'.r.
�� «�,�a
w othu owner or
AdC2ss of assignce (num6eraM sveeL ary. sia[e.
�-ooa. ����-o,
acc meeetear�ss �npaN as m n1a,
rear _ aare
IJSp A
state. eM LP cade)
tt owned wiM someona dher ihan spouse,
counry
ciesoN couNrv
Record ryambps Pa�
unpaid az d Is Ne ePP�t Vre sde
� iepal w e`ryntade w.neP
n Yes ❑ No
Is Me property m Queslim: MmiaOy Asessed
❑ Real ProPenY ❑ ��Y �
Moaie � nc ��.
� Dces ePplifam ovm yoperty in any oNer I If yes. wha[ m�ntyt I Wtwt Ta�dng Districtl I Has Iha deduUirn Eeen repuested m property I
munry in Indiana? for wrtem yraR
❑ Yes ❑ No ❑ Yes ❑ No
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