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a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County i i,hip ai,
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FOR DEDUCTION FROM ASSESSED VALUATION
".. t-�� State Form 43709(R11/6-09) •.••.•:f '.J .
Prescribed by Department of Lod Government Finance �Iq��rg
INSTRUCTIONS: ' IPU''rli 5 2013
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form iced
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought I (/I n;Mr
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file during the twelve(12)months 7-.V�•'r��'
before March 31 of each year the deduction is sought. G I=+O w Os' • -1 g ITOR
See reverse side for additional instructions and qualifications.
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•alb roc. / cf 'aCl�.'-O5/01 o -W/4 ' Oa 2 Record number Page /r
Assessed value of rd..•..n as of Mortgage/Contrail indebtedneee���unpaid as of �rtgage I Contract indebtedness unpaid as of Is the appliplicnntt the sole
March 1,anent year March 1,aurent� � date of app6ption I legal ❑ ❑owner?
year
G77 Yes No
If no,what is his/her exact share of interest? If owned with someone other than spouse,Indian with whom
If name on record is different than that of applicant,Indicate below property in question:Annually Assessed
Property p Annually Assessed
I Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller ,]/'7 •
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Address of mortgagee or contract seller(number and.shee pry,ate,and code)
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Name of assignee or odder owner or holder of mortgage /V/ d
>9 e I; IJA /-74° I Address of assignee(number and sbeet my,state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested an property .
county in Indiana? ❑ No l for current year? ❑ Yes
❑ Yes ❑ No •
Deduction approved in the amount at i7.� , " ' I
20 20 20 y/////^///����0./J� i 20
Signature of County Auditor (/ l (i!'�' Date(month,day,Year
I/We certify under the penalty of perjury that the abc i applicant is a resident of Indiana and
owner I contract buyer of the aforementioned popery 1
id SignTo/`,pg ff n:ng�)`1 7 _ 7 • - 4ncent'Date(rtwim.d ay,year)/Ft ,/)/r y//iess oof /YS//(/ j/!� e.sad zrP e) •}J 0 �li / llO��Person autttor�d by dory execoted Power of Atlnmoy or IC G1.1-12-0.7 //_ / e(rnwbh,day,year)
Address of authorized person (number and sheet wily,state,and ZIP code)C/ I
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