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°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
,_ • FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R77/6-09)
' ,�' � Presmbed hY DeP'��rd a1 Local GwemrceM Fi�nce
w.
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor or Counry Recorder o/ the county where the property is locatep. N��' m 3���
Filrrg Dates: 1) Real PropeRy. Must file during the year (or whlch the deduction is soughG JH ��unty fwditnr
2) Mo6i/e / Manufaduied Homes rrot assessed as Real Prt�perty Must file dunng the hxelve (12) rtwnths
before March 31 of each year the deduction is soughG Co Recorder
See reverse side /or adtlitional instnxtions arrd qualfications.
Aa (ownerorconvactb�ryu'seerestn�tionson versasLie) �
/
Y-
T ' {(ey riwnCer / le9al Eetai ' Rem�tl number Page numbrl
, 2� —J �/ - c�— � op. DDO. �8�- o� � . ''J a
Assrssed rahre of real property as d Mortqage / Contract 4Wehted�s unpaid as o( MMgage / ConSatl indehtednass unpaid as of Is Ne sPP��t Ma sole
March 1, m�erY year Marrh 1, wrtent yeer date o( a0 legal or equitaNe axnM
3 (� � ❑ Yes ❑ No
If ra. what ts h's / her exaU share ot interest? tt awned with someorie oNes llian spo�ae, udi<ate wilh vAwm
I! name m 2cord'a dtRerent Nan thal ol app9cant, Wita� h¢Ww
is C�e pmprlty in quesCOn: AnnuaOy Azsessed
Real P(oPenY ❑ ���Y �
MoWle Fbrtre C 61.1-7)
Nartre of rtrortgagea or mntratl seller `
Addrea af nnrt9a9ee ar mntrarl seDer (number aM sbeef, cily, state, arM ZIP code) �
Name of asvgnee w othu ownu or hdder of mwtgage
AE02ss of a,signee (numbera� shee4 tlry, stEte, an0 LP code) �- � �
Dces epP��� � P�DeRY in aM oNrJ If Yes. what county.� VJt. ,�'�� �G�`� �y
munrymindiana? ❑ Yes ❑ No ��j 1
� No
COUNTYAUDI � �� ��p
DeducCOn apprw�.-0 In �he amwnt of. ���
20_ 2q_ 2[1_ 20 [0_ 20_ 20_
SignaNre W b Audimr - Counry Date (monM, daY YEa�
I/ We certify under ihe nalry of perjury that the above and foregoing infortnalion is We and correct arM that Ne applirant is a resident of Ind'qna ard
owner % mntraa buye of ihe aforementioned properry on date appi&ativn is filed.
Slp mme h� na ) Date (month, daY. Yee�
tlress o app n num6era sbee4 tity, sCtate, erM LP code) y
z S�J � G7�O�O�
r�son au Dy Wy exeatetl Poxcr of Attuney or by IC 61.1-72-0'7 p� (��ry. �Y ype�
Add2ss o( authw'¢ed C�son (number arM sbee4 �+N. ��e, and LP mtle) . '