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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
: FOR DEDUCTION FROM ASSESSED VALUATION D tit State Form 43709(RU/6-0g) f
Fla Mark
Prescribed by Department of Loral Government Finance
INSTRUCTIONS:
b be filed in person or by mail with the County Auditor or County Recorder of the county wh tjje 2r�er�j(�}4ocated. Farm t with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Auditor
2) before March Manufactured 1 f each year not edusson i as Real Property.Must file during the twelve months
before March 31 of each year the deduction is sought �/(���- County Recorder
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See reverse side for:••it6onal instructions and qualifications. P.( SC)N col IQIIQ R
AppfraM(o • or• r see resttr)ee)pns on rse e) l '
t �1�, i
T - District Key /legal description Record Page nyurir
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t_, t b arc-1931- oi-Doo.a8c' -off � U
value cereal property as of Mortgage/Conrad indebtedness unpaid as of Mortgage I Corn-act indebtedness unpaid as of Is the applicant the sole
Mardi I,current year March t,cement year data of application legal or equitable owner'?
Cg OPCO El Ye5 ❑ No
If no,what is his I her exact share of interest? / If owned with someone other than spouse,indicate with whom
If name on record is ddferent than that of applicant.indicate below Is the property in question Annually Assessed
❑Real Property ❑AnnuailyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller air43 G Go x...
,
Address of mortgagee or contract seller(number and street,dr s
y,sate..and ZIP coddee))
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,coy,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property .
county in Indiana? for current year? ❑ No
❑ Yes ❑ No ❑ Yes
-- -
-- rnuTY AUDITOR
Deduction app, � a1 Snf,Ir�IUL e-y�7 kJ
20 J1j1 h4 Z.J z 4 J 200 20 20 .
—
./ . v. /_4^�4 County
Date(month,day.year)
I/We certify under the penalty of perjury that me aw..._.._._ formation is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
gnaaue(.�, r's hill reme) L9 � // Date(math,day.Year)
en resident ad._ applicant(number and street.(sly,state,and ZIP code)
+y^J'.oar/2A) srf4vtsSr.9di IA-c/ 637
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,dry,state,and ZIP code)