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t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun jI 44,i
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FOR DEDUCTION FROM ASSESSED VALUATION M
:� State Form 43709(R71/6-09)
Prescribed by Department of La Government Fna
File Mark
INSTRUCTIONS:
Y County County county properly F. ;1I—:r'_
To be filed in person or by mail with the Court Auditor or Court Recorder of the court where the ro is located. 71�• ��r
fling Dates: 1) Real Properly:Must file during the year for which the deduction is sought GI SO M �pQy>42WF1DIT0'
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 • County Recorder
See reverse side for additional instructions and qualifications.
Appficantrr or contact buyer-see
... on raversside
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•Di ' -Y legal description
Page number
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sIL 1 al ;. .. ►1 c4(., - 1.9- ( -tl ion - or)o. R `l5 - eel el ht.S a-c c%
real Assessed value of r property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebteM unpaid as le the applicant the sole
March 1,anent year March 1,current year ry /-� date of application legal or�quitabe owner?- vCt)bD es El 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,bid ca te below the property in question:Annually Assessed
eal Property ❑AnnuallyAssessed 1.1-7)
• Mobile Home(IC f rtgagee contract sellrf -
Address of mortgagee tract seller(number and street.city,state,and ZIP code)
Name of assignee or other owner or balder of mortgage D/:])lie \
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Address of assignee(number and street city,state,and ZIP code) `-7I'�I \t —
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Does applicant own property in any other If yes,what county? - What Taxing...- •• (edc
county in Indiana? �tr� (�/
❑ Yes a- No
COUNTY AUDITOR
Deduction approved in the amount oh r
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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 1 contract buyer of the aforementioned property on date application is filed.
ratre[�.ow1y/q,� me) Date(month,day,year)
ON 1
eFgl resident a o appruanl pR1F r andp[et.city and •code)I
l1I3CtirjAbSt 416 it's .. U q%37
emon authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day year)
Address of authorized person (number and street city,state,and ZIP code) .