Mortgage_Earles"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun shi Year
• FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (R71 / 609)
, P�esm'Eed hY OepaNrreM af Lnfal Govemrtrenl Fnance
� File Mark
INSTRUCTIONS:
To 6e filed in person w by mail with (he CounryAUditof or Counry Recortier of the county where the property is located. �
Filirg Dates: 1) Real Property: Must file during the yearlor which tha deductlon is sought. a Coun uditor
2) Mo6i/e /Manufactured Homes rrot assessed as Real Property: Must frie dunng the hveNe (12) months
6efora March 31 of each year the deduction is sought e�ef
GIBS
See reverse�lde for additional instructiw�s arM qualifications.
reve sne�
�AQ/ES
Key n / Iega'l /DesmDtim / Rem �Oer Pag�numbu
— Y — Q—��Q.O�%% QQ�o �
Abrtpage / Contract indehtedn�s unpaid a of Mortga9e / Con�aG IMebteOnest unpaitl as d Is ihe aOW��t Uie
Mart3i 1, curtent year date of aPP�� le�l w eWitable wmrYi
� O�� ❑ Yes ❑ No
mtemst? rc ownea vrim snmeo� wha. u,an soase. inaka+e wrt, whan
tl name m remrd is dMerant Uan Nat of appfrant, hWitate 6elow.
R
Name M mwt9a9ee w mntrxt seller — - .
Addr� of rnort9a9ee ar canMact se0er (nunbv aM st �''1 ^?-J�� �� �" ��-I.CS
Name ol assi9nee w oMu awner or hdder of nprtgag� /�� I I 1�� /
lJ
naa�s o� �� (�,� a�e so-eet car. smte. ar
Does eppluant wm ynperty in any oNer
munryinlndiana? ❑ No
❑ Yes
peducGOn appfoved m Me amount of.
20 2b
Sig�aWR ot Counry Auditut
I(ye5,whatcounD/t _ _
Iv�n.._
COUNTYAUOROR
20 20
Counry
pfoperty in QueStio
ea� Proa�v ❑
Ifor cu�rent yraR
20 20
Date (mon(h.
sted m PmpenY
Yes ❑ I
20
II/ We certify under Ihe penalty of perjury U�at Ihe above and foregoing intortnation is true and cortect arM that Ne appiipnt is a resident of Indiana aM
owner / Fontract buyer of the aforemeMioned pmperry on date application is filed.
\ . ��pye /s rytp / Date (nontl�. daY. l��
"� A
W Attarney w by
Address o( authoraed persm (numDer a� sCee4 cury, s+ate.
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