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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Fwm a3709 (RS / 4-03) � .
Prescn�ed by Department of Loral Govemment Financa
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INSTRUCTIONS: File Mark –,�--�
To be filed in person or by mail with the County Auditor of the county where the property is located. �� F� � � {,
Filing Dates: 1) Real Property: During tfie 12 months belore May 11 0) the year the deduction is to 6e�eflective. !�, ,d _,J �f
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year fhe deduction is to be effective.
See reverse side lor addilional instructions and qual�cations. � QN 3 � 2��4
Tauing Distrid
�!�/i!�
Assessed value of real property as of
March 1, curtent year •
Ii no, what is his / her exacl share of
on
side)
Cia�\ C^ � .'v .:
Key number / legal descriplion _ � Record number
OO^' Q/� � � _ � Page number
Ol
Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, wrrent year owner? ❑ Y�s � No
:�
-7 a oc� � -i3- o- �v.00i 33s-cn�
If owned with someone other lhan spouse, indicate with whom.
name on record is different than that of applicant,
of mortgagee or contrad seller
below:
Is the property in
❑ Mobile Home (IC 61.1
Address of mortgagee or wntraG seller (nur8j%r and street, city, state, ZIP
--- — -
Name of assignee or olher owner or holder of mortgage C�..ii'�
Drawer 0:...��.,,,
Address ot assignee (num6erand street, city, sfate, ZIP code) /,,
Card \TO. .....5-Y��.....
Does applipnt own property in any other If yes, what county? 1 �!7a L p„i., p(� I�y ��� requested on
county in Indiana? � � J���� ? 0 Yes� No
COUNTY AUDITOR
Deduction approved in fhe amounl of:
20 � 20 20
Signature
20=�( 20�
P P
County Audilor
20
I/ We certify under the penalty of peryury that the above and foregoing informalion is true and corred and that the applicants was / were
1resident of Indiana and owner of the aforementioned property on March 1, 20
Full
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Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person