Mortgage_Burger.a°^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou wns � ar
. FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (R8l 2-07)
�' „a � Presrnbed by Department of Laal Govemment Firance
�nrsrnucnoNS: � " " '
To 6e filed in person or by mad wdh fhe CountyAudito� of tlF w�.ny ..nena mapropeny+� w�.e.o... `-yn ��
Fding Dates: 1) Real Property: Dudng the 12 montl�s before June 17 of the year the deduction is to 6e eflective. o'�
2) Mobile Homes assessed under IC 64.1-7: Behveen January 15 and March 2 of the year tAe deduc6on i5 �� be eB�NTY AU DITOR
See reverse side 1or additional instructions a�M qualificafions. �' S��
see re9ric6ons on
Tariig Dis4icl • ' Key number I legal de:
(.(�ru.o�v a!o _ � 8 _
Assessed value of real PmpalY as d March 1. arrenl y�r I
Ihal of applicant i�ple belo+r.
Name af naAgagee or mnUacl seller
% Ra++ ^
-3c�0-00�. 6Q D�,r �� �
/ ConVad indebtetlness unpaid as af Mamh 1, Is the appticant Ihe sde le
Address of rtartgagee w mnlrad seller (.wmoer and A2el. dry, state, arM ZIP oode)
Name of assgnce or dher owne� or hdder of mortgage
ami sVeeG dty, state. arb ZIP oode)
someme Wier than spouse.
_... eR
❑ No
Is Ihe p�operty in question:
� Rral PrOVertv ❑ Mobile Hwr�e (IC 67.
pce� applicyn( pwn propeM in arry dher If yes, whal counryT What Taung Districl? Has tha dedud'qn been requested on property�
counry in India�? tw artent yeal)
❑Yes ❑NO �Yes ❑No