Mortgage_Herren^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
, c=_..
� FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-W)
�' µ� � Prrsm'6ed q' DeP��rit af Loml GavemmeM Finamx
lNSTRUCTIONS:
To be filed in person w by mad with the CountyAuditor or Counry Recorder of the counry where the propeA}
F7'mg Dates: 1) Real Pmperty Must file dunng the yearlor which the deducfion is sough[
2J Mo6Be / Manufactumd Homes rrot assessed as Real Property: Must fite dunng the hvefve (
6efae March 31 of each year the deduction is sought.
See reverse side 7or addrtional insWCfions and qualifiptions.
�
Asessed rdue d 2a1 popsty
Mstdt 1. amenl Year
Ii ro, what Is his! her e�ct sh
� �- U - UD /
:/ ContrarY inde6tedness Unpaid as of Mon
airtentyear date
It name m �ecwd's dMerent ttun that ot aOP�L ��te Gebw:
Nartre of mort9a9ee w tontrarl seller
Addres of mortga9ee w contrad sell
Name ai assignee or othr! ovmer or ndtler oi mwtgage
Address of assi9nee (number arid stree4 �+N. slate, aM ZIP cade)
po¢s eDP�innl own Woperty in any oNer If yes, wha[
counry in Intlia�? ❑ Yes ❑ No
aM
Page
btedness unpaid as d Lv Ihe aOP� nt Ne sole
kgal or epuitade wrtren
� � ❑ Yes ❑ No
spaae, irdkate wl�h whom
�Ris�y¢ propertyinqu�non:MnuallyAssessed
eal PfoPenY � %?�!�Y.� . .
WhatTa�dfg Datritl7 I Has �his Oedudion Deen requested on D�W�Y
kr wrtent yea� � Y� ❑ I
Deductlm approved in the amount oE � � ,'^,� �2
�•� ��� ��' �
zo _ zo _ �
�re�o,��ry��, � a-3��
i I We certify under the penalry ot pE
owner f mntract buyer of the aforen
Sigrehye (ownefs luu name)
r �-� _ �
Adtlress W
7 appaant (nu�€rard stree4 WY, �te, antl �L-P cotl
t.._1 S'iLi1K0 ST TO Rr
fuy emcvted Power o(Atmmey w by IC G7.1-72-0.7
person (num0er and sfreef, city, stare, and LP code)
zo _ � 20
IDate (rtmfh, daY• Yea�
�ct and that the applirant is a resident of Indiana aM
Date (month, day, yee�
'n,D�A�.IA y�JGYB . .
�Date (rtronN. daY.Y�