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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
'� ' t G FOR DEDUCTION FROM ASSESSED VAIUATION Coun Township Year
�. ._«. ! Sute Porm a3709 (RS / 4-03) _ . , �tt �.
PresrnDeO by Department of Lacal Govemment Finance " i� �� i� �_q �� I,�
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INSTRUCTIONS: SEP i J Z(Fj� Mark
To be filed in person or by mail with the County Auditor ot the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year the deduction is,to be ef/ective� � ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year_the deduc[ion,is.fobe ehective.
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See �everse side for additional instructions and qualifications. G�,3cON C �'� '
Applicant (owner confracf buyer- see
Taxing Distria
���.
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share
Key
Record
— CO o�
� � � �/ — � Page number
Mortgage / Contract indebtedness unpaid as of Is the applicant th ole legal or equitable
March t, current year ownef? Yes ❑ No /
�o'�/o0 6 c�� - �s- -�ao- c�o. (�s/-G��"
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate betow:
Name of mortgagee or contract seller
� G N,��-
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP
Does applicant own property in any other I If yes, what counry? What Taxing District?
county in Indiana?
20
Signature
approved in the amount
20
COUNTY AUDITOR
20 20 � 20
� �
County Auditor
Is the property in q�y�tion:
❑ Real Property ❑ Modle Home pC 61.1-�
o�- 3�q
Has this deduction been requested on
property for current yeaR � Yes� No
20 � 20
�
Date
I/ We certify under the penalty of perjury that the a6ove and foregoing information is true and correct and lhat the applicants was / were
�sident of Indiana and owner of the atorementioned property on March 1, 20
(owners full name)
�
Person authorized by duly execuled Power of A�torney
or by IC 6-t.t-72-.07
of authorized person