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'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_. _: FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fortn 93709 (R71 / 6-09)
� f Presaibed Dy Department al local Gwemment F�unce
�� File Mark
STRUCTIONS: �
To be filed in person w by mail with the CountyAUditor o� Counry Reco�der o/ the oounry where the property is F«m e�
Fiting Dates: 1J Real Property: Must file during the yearfor which Ne deduction is sought. n uditor
2) Mobde / Manufactured Homes rrot assessed as Real Property: Must fife dunng the (welve (12J months
betae March 37 of each year the deducfion is sought. ❑ County Recorder
See reverse side /or additional insWUions and qualrfirations.
��T �
. �wrreroroontraubuyer-� resfri�wismreve�esede) /% /�. . __ ' � C.�.�'_7A _..
/I // ! /
A�ssee vapu of Ral p�openy as ot
Ma�di 1, ament yeer
Key rnunber / kgal descnptipV
a� - � � -�3 - �
Mor(qage / Cantract u
Mamh 7, Wrtentyeer
rc�o.�i�nsin���or���»
on �emrE 6 6flefeni lhan
f mutgagee a oontrxt v
of rtioryagex m m�trad
app6cam, ubicate bebrr.
of ass�ee v oUer owner or hoNer of mortgage
�
smM,
�� OOO . I ot — O d, % v"'�,� ��'v�,N' + AUDI OR %
biedness unpaid as d Mortgage / CrnVaIY indebtedness unpaitl es ol Is Ne apPtirant the sale
date of appliqtb!n I¢gal pr ¢qWtade ameR
✓ � � Q (� ❑ Yes ❑ No
ot assignee (number erM streel, ary, sfa;, a�LP code) � O L�� _
c%%.i 3 d, �
any
approved'u� Ihe amount of:
synanae W Coimba�tlimr
sva,se. �a� wm �„
Is tlie {wperty in Ouestim: Mnuaoy Assesse0
��R"eal RoPertY ❑ Armuai�YAssessed
If yes. what muntyt What T.� "- "-'--�"- ---- .Has ihis deEUUion Geen rn
�UU� f����i S
COUNTV AUDR•
V 1 � �-
�— i p— , zo
la—y�y�
P�W�nY
�❑ No
I/ We certify undel the penalry of pLrjury that ve arW foregoing infortnalion is true and corte[S arM that the applinnt is a resident of IrWiana aM
owner I contracl buyer ot ihe afaementioned erty on date application is filed.
Sigpqw (o e/s name) Date (rtanfi, daY. leeA
��
Fu�l fesident adOress o( app�cant (number and sbee4 m}; state, aM ZIP ooNe)
INoB S. ,M� pe.. �R�N«�,,,.Z',� �/7c�v
Pelson auttwrized Gy duly ezeated Power of AttorneY m by IC 6-1.1-12-0.7 Date (rtpnlh. tlaY, yea�
person (num0cr arM shee; c4y, state,