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�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Caul Township near
`'A FOR DEDUCTION FROM ASSESSED VALUATION �l 1 I L p 7 j
State Form 43709(1111/6-09)
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS: ' -T ,. i , .
b be filed in person or by mall with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. II 1
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months 'I r
before •- •h 31 of each year the deduction is sought
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See reverse side for add.. :l instructions and qualification GIBSO _ . . - . : . _
App&am(owneror.. .%buyer-.see Key Tad /• / �I/07/!J So V-A.4-.D. J/2 Qo?Y ,(Av num/ / o.r / ,s
Assessed robe of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Conn•gdebtedness unpaid as of Is the app�+t the sole
Manic 1;anent year March 1,current year date of appr�t. lr , 76 legal or e0uieble owner?
yU� //V ❑ Yes ❑ No
It 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 property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile I-lanie(IC 6-1.1-7)
Name of mortgagee or contract seller _i
Address of mortgagee or contract seller(nun and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet call,stale,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? parent year?Yes ❑ No for
❑ Yes ❑ No
COUNT p _ �/ /J �/ -1 /
Deduction approved in the amount of: /& r d, �C_/f -/1 /� L L .
20 20 20 20 Drawer NO / i. 7/-5
re
Signatu of County Auditor - 2/,-a _2o/4'
Card NO.
1/We certify under the penalty of perjury that the above and foregoing ink p 9.4 f Indiana and
owner I contract buyer of the aforementioned property on date application $p 1 /
FulWesident of applicant(numbekr and street aly,state,and ZIP code)
gin 6 150 , , n IV 417&10
Person authorized by duly exearte(d Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized orized person (number and street dry,state,and ZIP code)