Mortgage_Robling^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship vear
..--
� FOR DEDUCTION FROM ASSESSED VALUA710N
• Sfate Form 43709 (R71 / 6-09)
'�' � Presrn'hetl M OePartment ot Laal GovemmerR Firwce
•° � ile
INSTRUCTIONS:
To be fi(ed in person w by maii with the Co�nryAuditor or Counry Recofde� of the county where the property is F m th:
Ffirg Dates: 7) Real Property: Must fi!e during the year for which the deduction is soughL �� County Auditor
2) Mo6r7e / Manufadured Homes not assessed as Real Property: Must fi!e dunng the hrelve (12) months
6efore March 3l ol each year fhe deduction is sought. - � ���QPb Recorder
See reverse side for adddional instructions aM qualifications.
!-
IMa�t(owrre�orcanjpUbN'�-see reverseside) � �
Assessed vdue
Ma�di 1. aarent
Ii no, what IS
zire
artent year
If narne on remrtl is dflerent lhan Nat af appGcanl, trMipte Eebw:
Nama of rrortgagee or cantraU seller .�� 7
Address of mMga9ee w mntracl uner (number entl se
Name of assignee or other owner or holder of morigage
�j assgnce (numberaM streeL dry, state, arM LP coda)
/�� `
Jimnl orm property ln eny ahu If yes, wha[ munt�/1
IMana? ❑ Yes
❑ No
_�00. �.3 a _.
ess unpaid as of Mortgage I Contrarl if
Eate of appti '
�
tt wmed wi� someone oMer Ci
3.fl 55 6
as of Ls Ihe aPP6rant Iha sde
legal or equitade owneYl
❑ Yes ❑ No
Is tlie ryoperty in 9���: a+nuallyl�ssessed
__ . ._�I.�__.._u.w_�..�M.
aa� Dra�ver NO.... �Q.�.�... —
55� �1
Card NO . ................ ....
� 79, 0 ,�1, �
What Tab� D'atric[? Has Nis detlutlim Eeen (e9ueste0 an P��nY
I fm °'rtern yeaR n No
n �as