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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_ • FOR DEDUCTION FROM ASSESSED VALUATION
. . ,• Sfate Form 43709 (R11 / 6-09)
,�'` � Presrnbed bl DepaNrieN at Local Govemment Firwxe
1
�srnucnoNS:
To be fi/ed in person or by mail with ihe CountyAudiror or Counry Recorder of fhe counry where the property is located. D E F A O�(�.
Fding Dates: 1) Real Property Must file dunng the year (or which the deduction is soughG �� C�ounty Auditor
2J Mo6de /Manufac[ured Homes rmt assessed as Real Property Must Re dunng the hvefve (12) months
before Ma/ch 37 0l each year Me deduction is srought C.� unty Recorder
See reverse side for addiGOnal inst/ucGons and qvalifications.
M ox�rerorcontrarJ.B`ael-seeresLirAxsonreversevdel . . r_�RC(1N
a� _ 1 —
ea.�are�a��iasm �Mort9agaic�raa�
MaCI 1. aamllt yrar AAarch 1, qlrrent yeur
If ro. what is his / her e�C share of interesY/
����
rtiort5agee w mno-an
o� assgnea w amer owner w naaer ar mortgage
ciry. sta'e.
-UU I —'O
unpai0 as a( Mwigage / Convac
date o( app�taqtion/
� O e
rc wmed wi� someare oNer
gnee (nu:n6er a+etl shee4 �1: sb1e, arM Z/P cotle)
ovm yope �any oN� C` If I�what m nu�jy�' I o
DeEUCtlon approvad in tlre amount oF.
O �!
as w
. ��..,.�...... �
�,��.
eppfrtant the sale
w equitable owneR
❑ Yes ❑ No
�-+�,n.nuestion:MnuaDyASSessed
�' •
�S�/SDi�. (� �`°� --
Drativer i\`O..
.���.....:
c���� lvo. ......��y�.....
o a- A �-
What Ta,dtg DistrirlT Has Nis EeOUCCOn 6een requested on property
for artem yraR ❑
❑ Yes
20 _ 20 _ 20 _ 20 _ 20 _ 20 20 _
Signawre d CamN nueiwr Counry Date (rt�ontl�. daY YEa�i
i I We certfy under the penalry ot p ry Nat Me above d foregoing infom�ation is true and mrtea arW Ihat Ne applirant is a resident of Indiana arW
owner I wntract bUyer of the afo entioned prope date appiiration is fiied.
Slg ownerS h� rema) Date (monN. daY. Ya�
FWI nt address of appaant (numbe�aM shee4 dty, te, arM LP mie)
j533 � I�DOS 1���{�-fczc�f, �hl�/71n�39'
Prisan authomed by d�ed F'ower of AttomeY w Dy IC 67.7-72-0.7 Data (monfi. dey, yeer)
Mtlress of auNwizeU person (num0erantl s�ee4 �1: slate, e� LP mtle)
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