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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couny sp , ear
FOR DEDUCTION FROM ASSESSED VALUATION
I: State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Fuarce
He Mark
INSTRUCTIONS: ! ' ! I . ' 1
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form Meg St
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought n, : -
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months
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before March 31 of each year the deduction is sought. W ecorder
GIBS• , •I . a : • • :
See reverse side for additional instructions and qualifications. number
Appfj�nd(ouner orpn uyer- restrictions
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Taxing/r Imo)(�/ra.Cy.F.CnI/// `/yF-�A ��d� /`^� 1 r�l�101�3l�,e1 j.G9i,y/1�, /a�/it-/o� C/KJ`J P[a/ 7" J
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of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year dat f a tion legal or equitable owner?
�j C� ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone r`than spouse,indkate with whom
If name on record is different than that of applicant,indicate below. Is dyer property in question:Annually Assessed
f\yFteal Property ❑Annually Assessed
LAC" Mobile Home QC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and meet,city,state,and VP code)
Name of assignee or other owner or hider of mortgage 1:I / 9726c_ 71-- 3-//
Address of assignee(number and street,cit state,and LP code)
Does applicant own property in any other If yes,what county? What Tarri ng District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No
❑ Yes El No
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1 ' IU�"1 ' E v Date(month,day,year)
�1j/./-���� ��--/1 1�_I� ,/�, /�/' onect and that the applicant is a resident of Indiana and
' .1� III I 1 JZ 0 l l_ G = COMPS(/ Date(� day,year)
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it log, coo ` 2(04
Date(month,day,year)
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