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gu STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
` St-h•Form 43709(813110.15)
Prescribed by Department of Local Government Finance q -_/E D
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INSTRUCTIONS: File Mark
To behled in person or by mad. - DEC 2 ' "';,.-•with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be Red or postmarked with the Count yAudrfor or County Recorder of the county wham the prope • is ❑ County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. •;1
2) Mobile/Manufactured Homes not assessed as Real Property.Must Re with the CountyAud r V r�{ie rtty Recorder
whew the properly is located during the twelve(12)months before March 31 of each year the d�t•,':.. - T • a a . it -
See reverse side for additional instructions and qualifications.
t(owner or•• buyer t nos on reverse side) - •
T. • District Key number/legal description number Page number
&-' alp -/X - / , - boo - ooh• SSA'-v ;.? A0f40 cy ).S ;-
Assessed value of real of Mortgage/Contact'indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dab•current year assessment date,anent year date of appration legal or emaable owner?
If no,what is his/her exact share of interest? If owned with someone other °4ndi h e with whom ❑ Yes ❑ No
If name on record is different than that of applicant,indicate before,: Is the property In Question:Annually Assessed
❑ Real Roperty ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller TFc Li -- -
Address of mortgagee or contract setter(number and street city,state,and ZIP code) i� __
Name of assignee or other owner or holder of mortgage ut•%)15'er 11r. rr ,^,
'''''C-21s)i•
Address of assignee(number and street oly,state,and ZIP code) -
Card Aro , //,
Does county applicant own property In any If yes,what county? • What Taxing District? Has this deduct .. �-/ �on ProPerlY for 1 other India ? ❑Yes ❑No anent year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtednea,..._
recorder's office(including any hone egwiy fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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COUNTY AUDITOR . - '
Deduction approved in the amount of
20 20 20 20 20 20 20
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Signature of CountyAudta 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/contract buyer of the aforementioned property on date application is filed.
_ powner's hit name) Date( .eat,year)
�i I raper f r+. !<� nt of number and street city,stale,and Z1P code)
n a2371Q g sue- it, 4,z/ f� t . Q x/74 >6
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 alt:state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.