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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CDr -t Year
�;; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance /
INSTRUCTIONS: Iiq M Ua 13
Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 0_a. .-.at• ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months �I, • q r,NN U
before March 31 of each year the deduction is sought - GI B SO Co M U
See reverse side for additional instructions and qualificat
7 owner orcontra uyer-see ions on reverse
Ta ' -Jisbict Key number/legal description Record Page number
a6 - 05 - .3cf_ Oyoo - 000 . ?9D -v }. 7 2W9
Assessed vako of real fists of Mortgage/Conrad indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1.cement year date of application owner?legal or equitable owner?
Q/Col 0 Q f n/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned watt 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
INtfleal
onsperty ❑Amorally Assessed
Mobile Huse(IC 6.1.1-7)
Name of mortgagee or contact seller l ,r (/' _ --
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �J`f IC pu 1 rot.i.,,_)
Name of assignee or other owner or holder of mortgage
Add? of assignee(number street,dry•state,and ZIP code)
. it 5 c,J(number
sE 3w - I — to ,Z Oc7 ' V y4 /J—dc9c/
Dees applicant own property in any other I If yes.what county? • What Taxing District?
county in Indiana? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature f� i , • County Date(month.day.year)
I/We certify under the penalty of perjury that the above and foregoing information is Due and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
\ &i re(owner's full name) \ Date(month,day,year)
Fun resid•'r:.tiglitfasaa•• t4 . /-re4 city,state,and DP coda) 4 /�
X /�r / / 7� .
II pc{iy(/��1. Ylci i ./�sf,7—%c ,,
Person authorized by duly executed.p(,*J.�-r of Attorney or by IC 6-t1-12-0.• Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code)