Mortgage_Fougnies"�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ = FOR DEDUCTION FROM ASSESSED VALUATION •
� State Fwm 43709 (R71 / 6-09)
S Presaibed by Departmen[ of Lo�l Govemmenl Frence
� File Mark
wsrRUCnoNS: � "-�
To be filed in person w by mail with the CountyAudifor or Counry Recorder of the oounry where the property is located. F� �� ��
Filing Dates: i) Real Propefly: Must 5!e durirg the year hr which the deductlon is soughf. � Counry Auditor
2J Mo6iie / Manufactured Homes lrot assessed as Real Property: Must file dunng the (weNe (12) monff� A
betore March 37 o/each year the deduction is sought. �'�R p:. �W�ri R��.
-_ �
See re�se side for additional instructions nd qualfications. n
a
Ap nt ownerormntrqebuYe4'i� 4^reverseside) . � ..._ �._ll iA
' �� �� a
Asses5e0 vahre of rral popertY az W MoKqage / ConbaU
Ma�d� 7, axrml year Marrh 1, arten[
If rw, what is ha I her e�d share of interest?
If narne on remrd'a dAterent Nan Nat o( applirant mCi�aQ: belo'�'.
5�,
Name ot rtwrt9a9ee a contraa seller
Address o( mortgagee «
(num6erarMShee4 �1
Oces aPdirant ovm pmperty in any oNer
munryinlMiana? n ..__
zo
Sig�L�re of
� antl sLee; clly, stata, aM [IF' ootle)
nqf�age
Dratver i1'OC�!QJ�
�
H awned wiM mmeane other Ihan spouse,
Ca r( d r,=q ,./0 73 =
amount of. �� � /� • • • • •
� + K. Fvu�'�
zo � zo , _
Counry
Is Ihe ePW�t Ne sole
legal w equitaNe ownM
❑ Yes ❑ No
�NN winm
Is tM property in Question: Mnua�y Asse55eE
❑ Rea� aroaenv ❑ nrmua�y Assessed
stetl an propeny
Yes ❑ No
•s'�
oa� �r�mm, dar. ree�
zo _
1/ We certify under Ne penalry W perjury that the above and foregoing information is We and cortect aM that the applirant is a resident of Indiana aM
owner / contraa buyer of the aforememioned pmperty on date appiicatlon is filed.
i'yna:_rc (o:.�iers lu0 name) Date (monfh, day, yeaA
riry, state, antl Z/P ootle)
by IC 61.142-0.7
of auNOraetl person (numDerarrtl sbee4 rJN. state,