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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
__ • FOR DEDUCTION FROM ASSESSED VALUAT� ���
- • State Fotm 43709 (R71 / Cr09)
t` „w / p�¢soibed by Deparhnent ot Lafal Govemment Frence
File Mark
INSTRUCTIONS: �nt,� q
To be h7ed in person or by ma�1 with Ne CoumyAUditol or Counry Reowder of Ne countyJlnCte Ae pr�� is located. F� �� '
Fifilg Dates: 1) Real Property: Must file during the year (or which the deducfion is soughG Counry Aud'rtor
2J MobRe /ManuFadumd Homes rmt assessed as Real Property. Must Red//nng the ve 7 ths
6efwe March 31 of eacA year the deducfion is sought. � _/ �/ __N-` � ❑ County Recorder
7JP�Pi1
Seereversesidefor�iditionelinstructronsandqual�cafans. niacnNC:nUNTYAUDITOR
rre�o�vma
Y�
m.
name m
Name of rtnrtgagee a contrxt
CWi� G �— v !_�ror�
that af app6�an� tr�Gnte bebw:
3. I as-��
��a � o, �a
Addrea oT mon�a9ee w mntraU se0er (numErl aM sbeeL uN. state. ard LP codej
Name W ' ee vm� or of mort9a9e ._
Ad assignee (numbefa�d L . slate. entl LP oode)
�O''� LU �.c �.vice — .�
ooes aaW��am wm v�cem � any ofher u res. wnat muntyt
counryinlndiana? ❑ Yes ❑ No
COUNTY
DeEuaion appiwad'vi tlx amount
Remid number
D / a-
o-�aeb�eaness w,aam as w Is me
��
spouse,
Is Ihe property in puestion: Mnu�
❑ Real Propetty ❑ Amlual
MobOe
r�
Yes Ll No
�g DCa�VCC 1�TO. `� :O.'. �.......
WhatTarir _ � ,
Card NO. ... �?..�r.�.. °?...:.{.�.
\UDITOR : �/ ry � "/
(9
20 _ � 20 _ � 20 � 20 _
Caunry
20_ � 20_
Date (naldh. daY•
/Z�7
/ We cerafy under the pen of perjury ihat the above anC foregoing infomation is W e and cwreG arW that Ne applirant is a resident of Ind�ana aM
wmer I wntrad buyer afo2mentioned prope date application is filed.
ayre (o h� Date QmiM, day, y9a�
/
rPSid WappOmnt(numberantlstraet, ty , PtnCa) -./ '�/
� O Gv � T iwG 6 /.v 1%6%O
:on autha'¢ed Dy EWy ezewted Poxer o/lllmiey ar by IC G7.1-12�.7 Date (monfi. tlay, yea�
ress af author'ved person (number antl streeS �: sfa[e, aM LP code) .