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