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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_ : FOR DEDUCTION FROM ASSESSED VALUATION
. . . .• State Fwm 43709 (R11 / 6-09)
�' u�. 1 Presmbed try OePM�M af Lad Govemment Fi`ance
11 rk
INSTRUCTiONS:
To 6e filed in persan or by mad witA the CountyAWitor or Counry Recorder o/ the county where the pioperty is bcatg�#- r�� ����
Fifilg Dates: 1) Real Property: Mus[ fi/e during the year Por which the deducfion is sought U t l, � �unty Audimr
2) Mo6de / Manulactured Hwnes /rot assessed as Real Property: Must Re dunng the txefve (12J rtronths
beforn March 31 of each year the dedudion is sought. C � Counry Recorder
See 2verse side lor additional in5trucGons arM qual"fiications.
nss�sea raWe a real papsty m n
AtBtdi 7. tlmerrt ye3r �
tt rq, what Is his / her e�cl share ol interesE?
If name on remrd is Nffuenl Uun that at appGranS
-1 - �.3 -�lO,l- p00
r�gage / Contrati Indehtedness unpaid as o( Moriga
mh 1, curtent yeer data of
tJame of mortgagea «contracl uller � �
Address W mortgagee or contrad seller (number and saee4 ciN. sbte.
Name o1 asslgnee w other awner or twlder ot mwtgage
Gti:f�i
Yes
approved in ihe amount al:
20 _ 20 _
y�anne anCo�mNya�iditcr�� �y
l: ' I : / ✓"V�'
I/ We certiFy under the penalry of p
ovmer I mntr2pt tiuyer of Ne afofer
Remrd nurnber
7! —�O
�� mde6tedness un0aid as o( 61he
� � �Q� ��
tt ovmed wi� someorre other than spouse, kMkate wlth whom
°r�i g /� g
It Yes. wha[ COUnt�? 4M21 Tavig Dbtr�tl?
COUNIY AUDITOR
20 _ 20 20 _
Is property in Ouesfim: Mnw
Real PfOPertY ❑ MobAe
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v�•a\ve�� ��'� �
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Cal.��p. .•�•��,�i�'
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Page numbu
dtade owne(7
Yes ❑ No
�_ � �_
Ihat the a a� foregoing infortnaGon is W e and corteG arM that the appiicant is a resident of Ind'gna a�
ned prop on date application is filed. �
1 � . Date (monfi. daY.1'aaA
�
Ce+son (numberaM sLCeG �: stat& end LP code)
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� - i � ��,. �y