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w�1 STATEMENT OF MORTGAGE OR CONTRACT D'lz a-.e County Township Year
hi; FOR DEDUCTION FROM ASSESSED VALUATION
.' State Form 43709(R11/6-09)
Presented by Department of Laval Government Finance DEC 1 9 2013
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder gg��thh�e rty is located. Form tiled wont.
Filing Dates: 1) Real Property Must file during the year for which the ded l/6bOUNTY AUDITOR /n County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must fie during the twelve(12)months /""
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications.
•...,. • , orc trace buyer-seere mreve side
I
Tayng rLStrict yea 7 ids G7- 2 �o no oa - 0 a I %3 P/7 a
�ssedv/�
March 1, vane of real property as of March 1, /Contract vsrdebtedness unpaid as of date of Mortgage/Contract indebtedness unpaid as of Is the applicant the wile
Mardi 1,avert year March t, date of apparatnn legal or equitable owner?
61J ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
Real Property p Annually Assessed
Moble Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contact seller(number and street, state-and ZIP code) --
Name of assignee or other owner or holder of mortgage - — -- /� --
Address of assignee(number and street ray,state,and ZIP code) `-' V U(///y�y/�( �N��� L'
Dees applicant own in any other If ��" t W
property Y Yes.what county? • wit hpuly
county in Indiana?
❑ Yes ❑ No /,3 - / 7/� ❑ No
COUNTY AUL.r urt
Deduction approved in the amount of:
20_ 20 20 20 20 20 20
Signature of County Auditor County Date(math,day,year)
I I 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!contract buyer of the aforementioned property on date application is filed.
Sionature(owner"fun name) 1�`1 `j/1/��.�(R�..1� P /� ^ Date(month,day,year)
Fut sent address,1 . . applicant(rlumberanTsbee t€,and L n r �r _A y `
A9 O Li) .S.?, IG LuP_A At �O. Qp t z to65
Person authorized by rdy executed Power of Attorney or by IC 6-1.1-12 7 ) Date(rtomh,day;year)
Address of authorized person (number and street.city,state,and ZIP code) .