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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7 Year
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FOR DEDUCTION FROM ASSESSED VALUATION
yt: :f:. State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: MA' • I
t b be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. r
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ...
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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. I ' - - �'
See reverse side for additional instructions and qualifications. GIBBON • • - • 2
Appticanl(owner or contract buyer-see rest 3ions on reverse side
Taxi gUDistrict ,/ Key number/legal d Lion Record number Page number
. • (7 - -
- / _ o9aloe- coo, 96 -o .1.i /0 07,336
Assesse0 value.:real....._ dot
Mortgage/Contract Indebtedness unpaid as of Mortgage I Centred Indebtedness unpaid as of Is the applicant the sole
A/arch t,. r ' Maw 1,anent year date of application legal or equitable owner?
CZ n 0 a ❑ Yes ❑ No
If no,what Is his/her exact sham of interest? If awned with someone other than spouse,Indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
0 Real Property ❑Annually Assessed
n Mobile Home(IC 6-11-7)
Name of mortgagee or contrast seller // r�./��l
Address of mortgagee or contract seller(number and street,city.s(pte,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
current in Indiana? ❑ Yes ❑ No for current year? • ❑ Yes
❑ No
COUNTY AUDITOR
Deduction approved In the amount of — -- __-
•
20 20 20 20 20
Signature of ty Auditor County i/�"(i/j'"� /0 'IJ36
I/We certify under the penalty of perjury that the above and foregoing information is true and c t
owne contract buyer of th aforementioned property on date application is filed. �r'— \/yl�-�,�(
k �``ewners �*•' . SsVa Quo 13 O,.oa✓le...L� l - Y
Full —'.en — of a.. ben and street,city,state,and code)
Pelson authorized by duty ex-. .. -core• of Attorney or by IC 61.1-12-0.7 Date(month day,yew
Address of authorized person (number and Sane ci0: r
N.
state,and