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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
,
FOR DEDUCTION FROM ASSESSED VALUATION ��If �� TT
r' fir State Form 43709(R71/6e9)
ED
Prescribed by Department of Local Government Fnance
INSTRUCTIONS
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.j U L N ein14 _
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Auditor
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. - ecorder
See reverse side for additional instructions and qualifications.
Ap ( or contact buuyyerr-see restrictions on reverse side) • • -
y �-_ -•'
Teri Distr Key /legal description Record pttpiber Page numbgr�
/2 Ala -/A_07 - yo a. - ,0a0 - Ps, - o a8 � ((( �J�//�QOJ
Assessed vabie of real popery as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,ascot year March 1,went year date of aP legal or equitable owner?
If/ 7 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone 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 ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller s
Address of mortgagee or contact seller(number and steel,city.gee,and ZIP code)
Name of assignee or other owner or holder of mortgage — '1 s
Address of assignee(number and steel,city,stare,and ZIT 1 y r7 , %)m W NITe {��\
Does applicant own property in any other If y V-� �LF•I J s deduction been requested on property .
wunry in Indiana? El Yes El No 114— 30e9 toy r? ❑ yes ❑ No -
Deduction approved in the amount of.
20 20 20 20 20 I - 20 20
Sgnahte unty Audios _ 2k64.1i....01, 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/coal, .• buyer of the aforeme.i•ned prop-• on date application is filed.
Signature(• r •”me) / Date(month,day,year)
�_ ice' - and ZIP code) �•
Full of aP t,umberand el 7t,city,state, ) Al,/,--- -e-- "- O
authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and street.city,state,and ZIP code) .