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"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
, FOR DEDUCTION FROM ASSESSED VALUATION
Sfale Fwm C3709 (R71 / 609)
�' ,.,, Resaibed q� oepannierd of l.aal covemrneM Fu�arca
INSTRUCTIONS: (�eG�ro�
b be filed in person w by mail with the CountyAuditw w County Recorder o/ Ne county where the property is bcated. r) �'L J�-� � �
F7ing Dates: 7) Real Property: Must fite during fhe year Por which the deductan is soughG �� Counry Auditor
2J Mo6de / Manufactured Homes not assessed as Real Properfy: Must file dunng the hveNe (12) monfhs
befo�e March 37 0/ each year the deduction is sayht � ��❑ ¢�+^�Y R��
See reverse side /or addifional insLUCliont aM qualifications. -' _-- .......�,�„
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� �'�'-� -oJ�.� �Ud�, VNCO- (/Qp� rrocom � r�a �Q
d nbrtpap e/ Contrau InOMteO�ss unP� as of Mongege I Con:ract uWebtetlncs unGaid as d Is ihe eGP�t the sda
Ma� 1, wrtent yenr Eate of aVP�tion �J Iegal v ewitade a�71
(/� ❑ Yes ❑ No
of intemst? If oxmed wiN someo�re ottrer than ."udicete wNh whom
i ihat o! aCV�4 trM'xate 6ebw. Is Me 7�v�Y in C��: MnueDy Asessed
❑ Real ProPertY � lvnivallY Pssessed .._
Name o1 mort8a9ee a mnttaU se0er
ACd`es d rtiortga9ee w mntraa se0er (mmi6er ar
Name o1 asvi�� �`-Clhdder d morq
��
AOCress of assi�ee (numbe� aM sneeL my. state.
Oces a�pliraN o.m poperty in any athc
mumy In Indiana?
❑ Yes ❑ No
Deduction aDW� in Me amouN of:
aM LP codej
Yes. what coum� I NTat Ta�drg DisUirll
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Dra���er \'0 ...................
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20 _ 20 _ 20 _ 20 2b 20 20 _
Syrenne N Camb nW rtw 1 I I Counh Date (nmth. dav. yea�
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I I We cert'rfy urWer the penalry of perjury that Ne above and foregoing infortnation is true and mrteG arW tliat the applicant is a residerrt of IrWiana ard
awner I contracl buyer oi Ne atorementimed property on date appliration is filed.
sio�n,re tou„crs nm rerrcel o-ate (mo�m,. aar, r��
�34(a si prviyu�
PaSOn autlnl¢eE EY dWY eze�tetl Power
e4 �ni: �re. LP ca
�ywDyIC61.142 .
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