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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` „-: FOR DEDUCTION FROM ASSESSED VALUATION
== a.5�;'J State Form 43709(Rl1/6-CG)
'-::9'7 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
1 To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is 1 Fam filed
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought CA i,
2)Mobile/Manufactured Homes not assessed as Real P during ( ) I ' • ; ty I door
Property:Must file Burin the twelve 72 m r
before March 31 of each year the deduction is sought - I !i •'-• ecorder
See reverse side additional instructions and qualifications.
Appfeant(owner tract buyer- restrictions reversiie) IOCT 21 2013
Taxing District Der/ gal d pb '� rtum•., I/,umber
. /-/0 -000- fail- Oat (��IT Il imlin r
Assessed value of real propery as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract bide6ttdns tNn.•... .f' X IhA-Q Few.
Marts 1 comet year I March 1''current year date of aPPacation I legal o equitable
Yes El No
If no,what is his/her exact share of interest? __ _ If owned with someone other than spouse,indicate with whom
If name c R nr7 t� Is the propem in question:Annually Assessed
��„'A/ e ❑Real Property ❑Annually Assessed
�0D 47-7-ft") I Mobile home pc Gt.t-T)
Address Nana of � / I
Name d a4 Dl� / 6 3 de) I
I
Adams ii/0/ ()/y I
Does at what Taring District? Has this'deduction been requested on property
marry i iM 4J �t for curtail year? ❑ yes
❑ No
Jo R AGe
�F �Cl n��i j )LINTY AUDITOR OR
Deduct tT I
2 1//�� J' ' 20 20 20 20
Scoot _/4 l 1—Re 10,9000 r os';-;Nb County I Dare(month,day,Y�0
I I' �C K, r�-7 ng information is true and correct and that the applicant is a resident of Indiana and
ow cation is filed.
I Date(month,day,year)
i
1
r nncil TN H 7698
IDate(month,day,year)
Atkin I