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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ � FOR DEDUCTION FROM ASSESSED VALUATION
•.. • State Fortn 43709 (R71 / 6-09)
� µ� - i p��y¢d yy p¢peNrrent o1 Lacal GovemrtreM Finarice .
File Maric
INSTRUCTIONS: g,„OAA,
To be filed in person or by mad with the CounryAudHor os Counry Recorde� o/ the county where the properiy is bcated. D E p-ZV�
Fiflrg Dates: 1) Real Property Must file durnig the year fir which fhe deduclion is soughL � County Auditor
2) Mo6de / Manufactured Homes rrot assessed as Real Properly: Must file dunng the hveNe (72) monfhs C. . o ry Remrder
betore March 31 of each year the deductnon is soughG �
See reverse side /or additional instructlons and qualifications. A D ITOR
Ap wne�wcontrac76uyer'seer�' 'r ^mreverseside)
�
T' �istri Key rvanher I iegal desaiption Recortl number Page numbu �
ab- _ o- ao_000. /3�-o a. � I
vahre aQ real p`operty as N Mw�qage/ Contract inde6tednrss unpaid as of Mongage / Contracl4debteMess unpaid as o( Ls Ne a0P�1 Ne sole
Mertl� 1, ar�ent year March t, curmnt year Oate of appli°f�p" legal w equitable ovrtcell
-/SQD� ❑Yes ❑No
FST.""I
Name a mortgagee «a
Addtess of rtwrt9a9ee w
Does applimnt own
munty m Indare?
DeAuction
ihat ot app6canl, trMirate Eebw
seller (numDer antl shB¢L �: sfate, aM LP c
x holder of rtpngage
streeG dry. state, eM LP m0e)
N� —/c�
y ame, ir res. �c m���yt
s ❑ No
amount
zo _ � zo _ I zo
signaMe w Ca�mb � r `
C . � '\.�Ohd°l?l>'�`
I I We certify under the penatty of perj thai the
owner I contract buyer of ihe atorementimed pro
Sigre owneYs hA rmma� /%
CP+�
. �
�S,¢G
VJhal Ta�d`g D'¢trict7
KI
za
E+ aM toregoing intortnatia
wi date appiiration is filed
r�sneet acry, sfate, enaLPOa
O
of Attorney w Cy I 61.142-0]
sneeS �Y, slate. anO LP cotle)
Is U�e property in questlm: MnuallyAssessed
�] Reai aroperty ❑ o,nnua�y a5sessed
n,u,n��, w,�„P nr. F
Flaz Vi's OedurSion Eeen re9uested m Propelly
mr a,rtem yeaR n.,_ _ n
�P7�,�, �
Dra�4�er NO.. a.0� o�
Card 1�'O. ...-.°�� '
Date (rr�onlh.
na arM