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^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Form 43709 (R71 / 6W)
S f p�m3¢p yy pepaMieN oi Lnfal Govemment Flnance
INS7RUCTIONS:
To be filed in person w by mail with the Co,urtyAuditor or Counry RecoNer of the courrty where the property is locate�o �
Fding Dates: 1) Real Pmperly Must fi7e durirg the year lor whicf� the deductlon is sought.
2) Mo6i7e / Manulactured Homes �rot assessed az Real Property: Must fi7e dunng the hveNe (12J monf�a �
6efore Ma/ch 31 o( each year the deduction is sough[.
See reverse side for addrtional instruc!lons and qual'fications.
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I MP��L�wne` w contrau buygr- see resfnLdorss rn rere+se sale)
Atmsed vdue ot � proprJry as d
Ma�� 1. amen� Sear
tt iw, what is his / her esact
If na(rie on
Key nu�ILer I Ie9aI desaiP�n
ab �8-36-y
�Apr(p�ge / Cantraa 4
Marrh 1, dment year
tere52?
o(aDP�L trd'uate 6eWvl
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AddRSS ot nwrt)a9ee or contraa se
Name a( asvgnee w other ovmer or
sbee4 u+Y.
dirant ovm property in �Ay oNu
IM'wia? ❑ Yes
❑ No
antl LP cotleJ
�If yes. what munlyl
Counry Auditor
Counry Remrder
RecorC numbet
o. 688= o 0 9 �
�aid as of Mori9a9e / Cm:ract 4tlebtedness unDaitl as d Is Ihe
datc of appfimtian � �
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�f ow�t� with mmeo�re otlw� tlw, SW�. md�te xM, whom
e pmpe�ty in Questio
rtea� a�oaenv ❑
�,��,y �e; scolT
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Y� u Na
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