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"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R71 / 6-09)
�' f PresciGeC by Depanmem o1l.ocal GoremmerR Financa
� II �
INS7RUCT10NS:
F
b 6e filed in person or by mail with the CountyAuditor or Counry Recortler o/ the counry wl�e`e the property is located. O C ��
Frling Dates: i) Real Property: Must file during the year for which the detluction i5 soughf. Counry Auditor
2) Mobde / ManuFactumd Homes rrot assessed as Real Property: Must file dunng the tweNe (12) months C,�,v��� C�
before Maich 31 of each year the deduction is snught. •�� Gounry Recorder
\� �
See revarse side for additional instructions a d qual'dreafions.
App5cant(9wre�orcontraabuyvs-see mreversesife) . •• ,•• -•
� - rr -
Asxssed rahre d real qoperty as d A1w(qage / Cantract'uv
Martli 1, aYfP1rt ytlr March 1, qirtent yPAr
tt no, what is ha f hu erart shara of infe+av?
I( narre m remd a Nifamt Cun ihat al appbra�v, cqicate bebw
Addres of nnrtgagee a contract se0er (num6e` arM stree; city, state,
Name of assignee or oUwl owner or hdder of rrortgage
AE4R5S assi9�ee (numESr aM atrecC �l: slate, aM LP CoOe)
�r s �g- a -�o . Ss
Does applicant own popgry in any dhei If yes. what countyl
munry in Indana? r-� ._ r-i ..
ction approveC in pie amoum ot
20 20 20
I/ We certiry under the penalry ot perj�f(y that the
owner I contracl buyer of Ne atoremerrtioned pm
20
-0�3.35�(-a
iE as W Mongage I Cort'vaG'v�Eel
tlate o( appGatia�„
O d
if ownatl wi� someorre other Ihan !
W�at Tadng Datricl7
20
Remfd num0er Page num6ni
o �- o � 3
unGaid at d Is Ihe aDW�t Ne sde
Yes LI No
perry in Gu�tim: MnuaM Assessed
PtopeAy ❑ArmuallyF�sses5ed
llra��•cr 10... ��•�..
Card NO. ......'••"��-/....
� I ,�I�� 79
20 I 20
hd foregoing infortnation is true and cortect ar�d that the applirant i5 a resident of Indiana aM
date applicatlon is filed.
Date (rtpnfi. deY. Yea�
n
Pe�.,on autlwr'¢ed Gy CNy ezeateE Power W Attomey m by IC 67.1-12-0.7 - Date (mmth. day, yee�
fddress W aWm�d pason (num6erariASVeet, dry, sfate, andLPcnde) . �
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