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'°�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form 43709 (R71 / bO9)
�' � Presmbad by �epertmenl a1 Local Gov¢rnmen( France -
File Mark
INSTRUCTIONS:
To be filed in person a by mad with the CourttyAuditor or Counry Recorder o! the counry wheie the properiy is Iocated.�p,N
fi7ing Dafes: i) Real Property. Must fife durirg the year Por which Ne deduclion is soughG
2) Mob�le / Manulactured Homes rrot aaessed as Real Property: Must fiie during the hveNe (12) months�
before March 31 of each year the deduction is sought.
See reverse side Poradditionaf insWcfbns and qualifications. �SD�
'� MP�+� (owner or oonlydU buyw'sre resbxLOns rn reverse sMe) i�` .
' 9 �is� U ' I d�
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M8td1 1, aa�Ent yPal
If m, whal is his I hef eud share Ot Nterestl
It name or1 remtl is Gilferent Nan Nat of appl
Narre af rtwrt�a9ee or mntraa seller _
i�-i� _•
e/Contraa4
. a�rrenl year
Pddress of mortJa9ee a mntrad se0er (num6e� and �eS �+�y. sta�.
Name M assignee w otlrel owner or holdu ot rtprtgage
AEdress ot as9gnee (numbrl aM stree; ciry, slate, arq LP rnde)
Dces ePPlirant wm property in any other
munry in Indiana? ❑ Yes
De�ucCOn appim�ed In Ne amwnt oE
20 _ � 20 _ � 20
NWitOr ,
�
- 000. lvYoi -o0 6 ao/ � / D
mss unpaid a of MMgage I Can•vaci inEebtedness unpaid as of ls Ne app�ant ihe sale
Eate of app�2tion lepal a equitable owneR
D O O ❑ Yes ❑ No
H ormed wiN somepne oNns n spouse. hMicate witli wlwm
�Is Ihe perry in question: MnueOyl�s.^.esuV
ProPeAY ❑Annua��YAs�ed...
— ��� ��� —
o� Drati��cr NO..���.,°�,
— Cal'd NO. ..�?�. 1�
............
— �i3�9ao.�_
20 I 20
20 _ � 20
Date (mwEh. daY.
I I We certify untler ihe penalry of perjury thai the above and foregoing infortnation is W e and cortec[ and that fhe applirant is a resident of Indiana ard
owner / wntract bUyer of the afotementioned property on date appliption is filed.
(°wn�s hdl �mel f) 17 / Date (rrArd�. daY. Yea�
sLee4 dy, sbte, amd
AECrassofaW�w'vxdpasrn (numberarMSbeaf,rity,
IC F7.7-12-0.7
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