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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION _
� . • Sfaro Porm 43709 (R71 / 6-09)
�' ! pr¢soibe0 by DepaMient of Laal Govemment Fu�ance
File Mark
INSTRUCTIONS: g
To be filed in person or by mail with the CounryAUditor or Counry Recorder o( the county where the property is located. � E � O
F7ing Dates: 7) Real Property. Must fife during the yrear Por which the deduclion is sought. unry Aud'ROr
2) Mo6�7e / Manufactured Homes rpt assesced as Real Property: Must file dunng Ne tweNe (12) months C. . Co ty Recorder
before March 31 of each year Ne deduction is sought.
See 2verse side /qr�dditional instrucGOns aqd qualfirations. ___ _,,,, rn� mYfY AUDITO
Keyruan0er/
A�¢sed rWue d¢� P�P�Y as of
Ma(a� 1, acrem yrsl ,
tt ro, whal is his / �u erad
m r�md is 6Remn[ than Nat ol appaant. trMinte Eebw
of mortgagee a mntract se�er
m,o-aa sener
Name of ysdgnee or oiher o�mer w
mortgage
Retortl numCei Page n
—Q -a,Ljp_oU�{_OD�.Z-ol/ �O/�. lo el7
ted�s unPaid as U Mon9a9e / ContrarY iMeM unPaid a d Is Ne sPV6rant the sde
year date of aGPGp[ian ' � 1.S� Q IeBal a eWilade ox+uR
n Yes ❑ No
state.
H ovmed with m�eone 6ihar �han spousa, iMirate Wih wMm
y�ee �ru,rr�ee. u,., v,m� u.r. � ow�,
9�10
ovm pro in any aNer If yes, what munt/t What
a� ❑ Yes ❑ No
I++srr ��ih..e ��property in Questian: MnueM Asaes:xV
�y+Ceai Property Q Armualh� Assessed
' \ Abdle Home (IC 6
� �03,500.°O �
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