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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,,.__ ,; FOR DEDUCTION FROM ASSESSED VALUATION •
SfatB Fortn C3709IR71 / 609)
�' w. � Presaibed by DepaNnerd a1 Lmal GwemmeM Firence ,
� .r
wsrRUCnoNS:
To 6e Red in person w by mad wifh the CounryAUditor or Counry Recorder oJ the counry where the property is Mc�t� 2
Fil'ng Dafes: i) Real Property: Must file dunng Ne year for which the deduclion is sought
2J Mobde / ManufaUUmd Homes rrot assessed as Real Prtiperty Must fiie dunng the fwelve (72) months
befora March 37 of each year the deduction is sougAt. �d-�•(.
See reverse side ifional inshuctrons arM qualifications. ' � J
Irow�n co�,.o, c i� �� ol ��`3 Yt rnwe�Ci�-� D:��'�^^^ oiea
� Distr'x1 Key rwmEer / kgal deuriptia
ab - ao - S-
iedralueaFreai{mprl;yasot �b�pape/Cantrz
7. a�m� yGr Mert3i 1. artent y
araG share ot interest?
Name of rtnrtga9ee a mntraG se0er
Addtea W mortgagee ar mntrad se0er (numbn� and streeL �Y state.
Name at asignee w ochn awner m halder ot rtKrtgage
Atltlress of assignee (number and sm
�
Oces e�i�N own yapefCj in any o1
munry in Intlar�a?
❑ Yes
D�urSon appmeed "v� Ihe amount ot
County Auditor
Caunry Recorder
o-ooa. o !-oo / o�oio (G/5`
'��,yoeaid az d age / ConYact'vNebtetl'mss unGaid as d Is Me aPP�t the sde
(JU(/ Cata ot appGmtian legal a equitade owneR
i
�f7 n Yes n No
H wme0 wiN somew�e ather ihan spouse,
a�e, env ur cma�
NW W�''� IS-3-9
—r .........w.,r,..,.�„M. __ _ NTalTarirgDistrict?
"- (nA2i�� �au� A �a��o.
- %�7�C NEcc- /� -
_ aU'o- �� -
Is Cre P�GertY in Oueslion: MmiaOy AssWed
❑ Rea� Roaertv ❑ /vmualH As�sed
MoWle Fbrtie (IC 6
p -8
Has Na deduclion Eeen requested m pmperty
farartentyear? n ..__ f'1 �
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I/ We cenify er Ne penalry of perj that the above arW foregoing infortnation is uu� ...... __._ _.x and that Me applicant is a residerrt ot Iridiana arW
owner I contrad buyer of the ato2mentioned property on date appfication is filed.
�� �O%�ia l!u0 name) r Date (month, daY. Y�
k � YV � ea�..L*N�
ess o/ appGrant (numberand sbeef, tiry,
C Co SO S Da
1 Ev dW exeaisl Pa�wer of Fttamev m I
pem.wi (num6eraid saeet, fily, state,
aM
�nz-0.�
o� p�nn. dar.