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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Untili IMy�i L:
•
FOR DEDUCTION FROM ASSESSED VALUATION:( Stale Form 43709(R71/6-09)
Prescribed by Department of Local Government Finance
F' 'rll. _ 1 2013
INSTRUCTIONS:
Form ed with:
To be filed in person or by mail with the County Aud for or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ttor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months GIB.ON-rPO � OFZ
before March 31 of each year the deduction is sought - LY
See reverse side for additional
tiopg
additional instructions and qualifications. n ' v
Appficancener or Taxing 'stria Key number/legal desaipdcn Recd number Page sum
d6,- 9-aG- o800_000. 432-O2er c2v/3 /2o
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,arrest year Mardi 1,wren year date of appy2 ibri/ legal or equitable owner?
IUC, f/F(-�,..(J ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is dtiterent than that of applicant,indicate below Is the property in question:Annuatly Assessed
Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / /( `
Address of mortgagee or contract seller(number r and street city,state,te,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 I If yes,what county? • What Taxing Dist ct? Has this dedumon been requested on property .
county in Indiana? ❑ Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR I-
Deducton approved in the amount of
2 91 toop r 20 20 20 20
Sgne (n�� ' 2 County Date(month,day,year)
Drawer NO °/ J
I l rregoing information is true and correct and that the applicant is a resident of Indiana and
\ a j 760 ,application is filed.
r Sign. Card NO. I ( Date(month,day,year)
code)
512E 9S co 5 H*0(357–Pi o- X3 X7634
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 street city,state,and ZIP code)