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. - STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township
Gip"`ysc: FOR DEDUCTION FROM ASSESSED VALUATION 1
State Form 43709(R11 1 6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: f r
Form" •R (- • •
Fs 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. I PI Coon. Au.',.
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. 11 • •...1-.fir TP•• .er
See reverse side for additional instructions and qualifications. GI- - ` - ` r. •
/Ap. or.. .tract boyar- --, -verses"w.)
T/ dT' KKee//yauurmber/(�,�o'/ia7 de(/_+ �f COO /� /J W 2 Record number Pageennriy/�t r
6 ./7 ! ` — jo - CW• QJO- W / �d ! (OS2
Assessed vat property as of (41-/(71-
ortgage I Contract indebtedness unpaid as of Mortgage I Contract'immmndddd,eeeeeehhbb66lltt��eeeeddddddnnnnnness unpaid as of Is the app�nt the sole
March 1, j March 1,current year date of applxatjpn flip legal or equitable Yes se
_a��off{{ ss r Y No
If no,what s her exact share of interest? If owned with someone other Man spouse,indicate with whom
if name on record is different than that of applicant indicate below. Is property in question:Annually Assessed
Real Property 0 Armually Assessed
Mobile
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller &say.
Address of mortgagee or contract saner(n and state[ ZIP
I
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,cay,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Twine District? Has this dedtubon been requested on property
county in Indiana? ❑ Yes ❑ No f w cu r ❑ Yes
❑ No
I
COUNTY AUDITOR
Deduction approved In the amount of.
. f
20 20 20 26 -
Drawer NO.. ....1_.5 i 20
........
Signature of County Auditor - 21 L year)
Card NO
I I We certify under the penally of perjury that the above and foregoing it 4132,10r•cP/ lent of Indiana and
Amer I contract buyer of the afore mooned property an date applintio
(owner's foe name) year)
h Sire o D I
Full resident address of applicant(numbe M te,and LP cold�e
�.1� 41190
wa a i�Nye' r•V'Y Q.
Person authorized by d executed Power of Atormey or by IC 6-1.1-12-0.7 I I Date(month,day,year)
Address of authorized person (number and street,city state,and ZIP code) .