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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun 7ownship vear
+ FOR DEDUCTION FROM ASSESSED VALUATION
� S1ate Fwm 43709 (R71 / 6-09)
ti � Presvf0ed by Department of Loral Govemrtrent Fnance
w.
wsraucnoNS: p
To 6e filed in person o! by mail wifh fAe Coun Auditw or Coun Recorder o/ the aoun wfiere the �, yi � O �
a a ty woa��r��«c. DE
FiRrg Dates: 1) Real Pmperty Must file dunng Ne year for which the deducLOn is soughL � j� �nry Auditw
2) Mobi/e / Manufactured Homes rrot essessed as Real Property: Must file dunng the tweHe (12) months C
betwe Mamh 37 0! each year the deduction rs sought. nty Recorder
See reverse side (or addiUOnal insfructions and qual�cations.
ppp[rent wnerorwntraobuyer-seerestrirb'w�smre side) ITOR
;G-�.,�.,�;,� !, � -�YV�en�.o�l,,•J.� � `yvu�l�6L.e�
t real ploperty as of
Y�
rq, what Ls his I her e�cc share of interesfl
� regai acsa�puon � rtemm numuer rnye ��u��n.v
-ia. �oa-oor.x3�,oa�� ao�� ��
Io�page/ Cantract iMebtednPSS unpaid es of Mortgage I Contrarl iMeMedness unpaid as of Is Ne epprrcant Ne sole
lart3� 1. curtent year tlate of appOCation legal w equita6le ameR
D ❑ Yes ❑ No
t/ owned wiN someone o ihan spouse, indipte wtth whorn
It narne on �em�d'¢ Eifterent Nan Nat af aPp6mnt, uWirate bebv`
Name of rtnrigagea or contraG s�
Pddres ot rrortga9ee w contracl
Name at a<m�ee w oUrer owner
avicef, r4y; slate, and LP oode)
Is the properry in QueSUOn: MnuaDy Assessed
��a�aenr Onm,�,ya�a
Mes epplitant own prope�ty in any ot�u If yrs. what muntyt Whal Tapng D"svict? Has t�is deductim Deen requested on p�operty
county in Ind"ana? ❑ Yes ❑ No �r W� � ❑ Yes ❑ No