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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County rthiti R 1 Year
:C._712:4 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11 I 6-09)Presrn'bed by Department of Local Government Finance
le Mark
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INSTRUCTIONS: I
Form fg:• i :
To be filed in person or by mail 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 ❑, •un • ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months LT ��,�-��.ecorder
before March 31 of each year the deduction is sought. GIB$.N • , • _ _
See reverse side for additional instructions and qualifications.
Apprrmnt(owner or contact buyerb'upyer--`see restrictions on reverse site)
istict r ( \ ey�number a9al desaipton Record number Page number
ccx � Di. - .)-&- 1 2yDN-Cb00,5a S - a,.a4 , a_ n‘ 3 359L
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
I.aanrnt year March 1,anen J current year date of application legal or equitable eerier?
e
D bbd lYes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate wth wham
If name on record is ddferent than that of applicant indicate below Is property in question:Annually Assessed
eat Property ❑Annually Assessed
• TT Mobile Home QC 6-1.1-7)
qo`frmortga'g'ee aor onut seller s,x1
Address of mortgagee or contract seller(number and sheet,city state,and ZIP code)
Name at 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? - _I What Taxing District? _ I Has this deduction been requested an property
county in Indiana? ❑ Yes r�-Tw�o ❑ No
COUNT Drawer NO �G�(j /�
Deduction approved in the amount of ,Gam!?! 0
Card NO.
20 20 20 20_ 0
Signature of Cocaty Auditor •
I I
II We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I tract buyer of the aforementioned property on date application is filed.
Signature hlue rams) 1 \ Date(month,day,year)
t
Fu resident address of applicant(number a sheet,gqlryy,state and ZIP code) q
'5)-87 e 11 .5 D S. Wginbsf '� FNO Y7(93 f
authorized by duly executed Power of Niamey 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) .