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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' J[,L. }gJ'I'atIk 1►,i Year
ba. ,d, FOR DEDUCTION FROM ASSESSED VALUATION
-cy.t-ck.t� State Form 43709(R11/6-09)
Prescribed by Deparbnerd of Lod w n
Government Fu
¢e 1 1 F r 1 9 2013
INSTRUCTIONS:
1 File Mark
To be filed in person or b mail with the Court Auditor or County Recorder of the county where the property I ymu
by h h h P piny is l....�,.. . �II.r
Ring Dates: 1) Real Property:Must file during the year for which the deduction is sought. n I r, r�sGOU r �CFORAudhor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twe fj§g
p'j/qn`"'^ ' YJ /) h 1_ ` ^
T G A� ` V1 W—/61 7-02 v1 J/COO(./j�l�J61--�O/l,cl IRemrdo ^ Page/ Lf3 7
of real property as of Mortgage/ et indebtedness unpaid as of Mortgage I Contract indebtedness unp�as of -Is the app ca l the sole
March 1,current year March 1,cumin{ysar3 date of application I legal or liable No
�J( Yes
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate i with whom
If name on record is different than that of applicant.indicate below. Is the property in question:Annually Assessed
•
�2eal Property ❑NmuallyAssessed
T - I Mobile Haile(IC fr1.1-�
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,trot state, ZIP code)
Name of assignee or other owner or holder of mortgage _
Address of assignee(number and street,rdy,state,and ZIP code) 1
Drawer \ UI/
Does applicant own property in any other If yes,what county? Wh: ProPerlY
county in Indiana? ❑ Yes ❑ No �/r rrr777
I /� ❑ No
Card NO. . I ���111
COUNTY AUC
Deduction approved in the amount at •
20_ 20 20 20 1 20 I 20 20
Signature of County Auditor Courtly (Date(month,day,year))
I/We ce ' nder the penalty of perjurythat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/it• buyer of the-.. -mentioned property on date application is filed.
` lure r Ys I% Date(month,day,year)
\/[J / r
;nisi t O ap number and street,iffy,scare, ZIP mtle)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street tlty,state,and ZIP rode)