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"'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTE�� C n ownship Year
s FOR DEDUCTION FROM ASSESSED VALUATION �
• State Folm C3709 (R71 / fr09)
�' � Presvibed by �eP��nt of locai Govemment Firence p E�.
File Mark
INSTRUCTIONS: �/
To be (led in Y ly ry ty P��loca�l' F� ��:
person a b mail with the Coun Autlitor or Coun Recorder o/ fhe coun where the ro JK^
Filirrg Dates: i) Real Prvperty: Must file durirg the year for which the deduction is soughf. � I�p�,�v, County Auditor
2) Mobile / Manufactured Homes rrot assessed as Real Property Must file during tF���� f�ddhY AU 'r��'
befora March 37 of each year the deducfion is sought u County Recorder
See reverse side la addifional instructions and qualilcations.
IApp(xa raroonvaUO r- rts rare sAe1
C�n��fl � ��-,��� a�,.�»,a .o n rn-�� � �
- -3d �.300 -c� �5d - ao
Asxssed vaqre of real poperty as o1 Mw�qa ge / Conbact iMebtetlness unpaiG as of MwYjaqa I ConSari udebtedrress unpaid as d I5 �he applkant Ne sale
MarCi 7. qamn[ year Mamh 1 a�rte�rt year datc of appGCaGOn legal w eqult2de oxne(?
� � ❑ No
tl ro, what Is his ! her euC share of interest? If wmeE wvh someone other ihan spouse, Indwate riM whom
tl name m record's CAerent fhan that of appOwnt, trMifate Debw: Is tice pmperty in 9uestion: MnuaOy Assessetl
❑ Real ProPenY ❑ !?"^!!�h' � '
Name at mwt9a9ee or mntract
rtiorqa� or mntraG seDet (mm6e� and sveef, �y. sfa�. aM LP code)
Name m asstgnee or ana awner ar naaer rn mor[gage
Address ot assignce (number aM snee4 �Y� �e, and Z/P tode)
Ooes aPd�mnt own rynperty in any oNer If yes. what i
counryinlnEana? ❑ Y�
❑ No
Deducaon a0 � �he artwnt oE
20 _ 20 20
sg�n�a or �.�r ��,l,\L
COUNTYAUDROR
� ��
.......
pl�a��-cr \0........ • .
� o . .��.`� 39 . . . : . . . . . .
�(��? _� �ItiS,S�•`�
�fla7�c�
20 _ � 20 _
Counry
20 _ � 20
Dale (rtbrth. CaY.
No
1 I We certify i}Wer ihe penalry of perjury Mat the a6ove arM foregoing intormation is true and cortect arW �hat the applinnt is a resident of Indiana arM
amer / mntract buyer ot the aforementioned proper�+ on date appiication is filed.
��wre (aymefs NO �ame) // /7 Date (month. deY• 1'��)
ss ol appfinnt (numbar
1 � v `]S
oy awr e=ew�ea aowe
��
stare,
sbee; ciry, state. an0 LP code)
oa�e (�r�ann. ear. r�
/v