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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun �'� + ;�'Ij)
(Aj.}.' FOR DEDUCTION FROM ASSESSED VALUATION
+vqs Stale Form 43709(RU/fi-09)
�,= Prescribed by Department of Lost Government Finance 1110/11111111
File vark
INSTRUCTIONS:
To be filed in person or mail with the Coun Auditor or County Recorder of the county where the re Form with:
oe by County ic h properly is located. �; 4i •
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. r fi 1 , r,[,
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months GI:S 0 M C f ' I bITO"
before March 31 of each year the deduction is sought. - • County Recorder
See reverse side for additional instructions and qualifications.
Appfxam�y (wyrrerw CV /; �on k-/O sale) 0 //S'y�/ /
�7B/D/str//'ct Y 4 v yJzr �Ln//rf/� K//IZjC�QJ-/3 3 -GY0.3o9- 06J— 0% P /�'
Assessed value of real property as of Mo�ya I Contract indebtedness unpaid as of Mortgage/Contract indebt ��unpaid as of Is the appfxant the sole
Marsh 1,one yew Alardi t9earnent year date of ape �,�f ^/yy� legal or equitable ovine?
/� � ❑ Yes ❑ No
If no,what is his/her exact share of interest? tf owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is perry in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ge/n--19A-a}Address of mortgagee w contract seller(number a ry.state,ard✓ )
Name of assignee or other owner or holder of mortgage `/r ( 1"
Address of assignee(number and sheet coy,state,and ZIP code)"Olt - ��1 ��IJ/�
county Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on properly
ar
❑ Yes ❑ No for rant year?
❑ Yes ❑ No
As COUNTY AUDITOR
swath- j r i m RW co _ 20 20 20 20
��„'i�J// �y / County Date(month,day.year)
U 7 ._._.....ive and foregoing information is true and correct and that the applicant is a resident of Indiana and
____.,..r,ur me aforementioned property on date application is filed. . •
S iiygapxy) 2. Date(month,day,year)
1 Fu%.,esdenntt address/,'oSff applicant(nnnuumbergel sheet,city state,and ZIP code)
,t ' ,/C
cS 1 O _ tic., �`l-- f-rc is scc }tsr C{764
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,wry,state,and ZIP code) _ \A\`
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