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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form a3709 (R4 / 70.01)
Prescribed by Depanmenl oi Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. 6 Z��3
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 of the year the deduction is to be effectiv� AN
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0l the year the deduction is�to be ef/ective.
See reverse side (or additional rnstn�ctions and quali(cations. �
GBSON pt1uTY AUOITOR
Appiicant (owner or contract buyer- se 2strictions on reverse side)
Taxing Distrid Key number / legal description Record num�r
Page number
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Assessed vatue of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applican�sole legal or equitable
March 1, current year March 1, curtent year owner? es ❑ No
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
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If name on record is different lhan that of applicant, indicate below: Is the property in question:
eal Property ❑ M�ile Home pC 61.1-�
�me of mortgagee or conVact seller
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Address of mortgagee o conVad Iler umber and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Tazing District? Has lhis dedudion been requested on
counly in Indiana? property for wrtent yeaf? Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 j2� 20 � 20 20 20 � 20 �� 20
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Signature _� �`�� County Auditor Date
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�/ We certify under the enalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
�A `��.. or by IC 6-1.1-12-.07
f I resident address of applicant Address of authorized person
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