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47 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County Township Year
:` FOR DEDUCTION FROM ASSESSED VALUATION 1 ,
- 1 State Form 43709(R11/6-09) - .111111\*
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Presaibed by Depanment of Local Government Finance - r ;_
File Mark
CONSTRUCTIONS: mark 7 pp 1
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is/orated. Forth file 10,2013
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ❑ -County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought L1/goon
See reverse side for additional instructions and qualifications. OtBsUN COUNTY A UfIIT
AppGcan ar conaarl buyu-s- .. anre • R
Taxi G.ct ' ey 6,3 % (IOC-600. 1 3 7-o d7 SC 6 i3 a�a32
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•.1.-M.I.vah a of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract i ebtedness unpaid as of Is the applicant the sole
.r+ 1,current year March 1,current year date of applicag // legal or equitable owner?
�0 U. a d ❑ Yes ❑ No
tf no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,Indicate belovc Is the property in question:Annually Assessed
p Real Property ❑ArmualtyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract selle� ^/4/n� •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)(? '�/
Name of assignee or other owner or holder of mortgage -
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Address of assignee(number and sheet,city,state,and ZIP code) -
Does applicant own property in any other tf yes,what county? What Taxing District? \ I Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No � for current year?
4 ❑ Yes ❑ No
® COUNTY AUDITOR -4 p/I I
Deduction approved in the amount of /•' \
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20 20 20 20 I 40 75 V ^=�•
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Signature of County Auditor County ,,,o..).
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and th.. /�� 7� .and
owner/contract buyer of the aforementioned property on date application is filed. W 3
Signature(owner's fu0 name) �r ''�/yt_y�/ pate J
Full resident address of aeortcant(num and sheet, ityJ/`,sstatete,and�J/�u'mael -_
/0/ 3 /- ( /avr&PS-rp Al 4"At c/f— .ffv 9 71P �1 ? --- — - -
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code) .