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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ �a� ! Siate Form <3709 (RS I 4-03)
� �rescriCed Cy Department of Loral Govemment Finance
To beR e�TlO� �n or by mail with the Counry Auditor of the county where the property is located. ��e� �j �
Filing Dates: 1) Real Property: During the 12 months 6elore 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 of the year the deduqtjoi�s jo �e t��tive.
See reverse side for additional instructions and qualiflcations. _
Applicant (owner or cront t b er - s_ ee restn
� � i N
/�,�u/i �
Tauing Distrid
` ` .
Assessed value oi real p p rty as of
March 1, current year
Ii no, what is his / her exact share of interesl?
If name on record is
Key number / legal description' —
�O l�0 _�a5�- �o. �aa =c�'
.. OO�as o(�
Mortgage / Contract indebtedness unpaid
March 1, wrreniyear
that of applicant, indicate
of mortgagee or contract seiler
OUNTY AUDITOR
number
Page number
as of Is the applicant the sole legal or
owner� ❑ Yes ❑ No
�� �
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contract selier (number and street, city, state,
Name of assignee or olher owner or holder of
of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduc6on approved in the amount of:
20 0 1
P
Signature
20
0
What Taxing District?
COUNTY AUDITOR
20 20 20
P
County Auditor
Is
:�SSI
❑ Mobile Home (IC 61.1-�
Has this dedudion been requested on
property for current yeaR � Yes � No
20
Date
20
We certify under the penalry of peryury that the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
n ne nam Person authorized by duly executed Power o(Attomey
or by IC 6-7.1-12-.07
3aaress or appuwnt Address of authorized person
Noc�. (�,� `4�c �x oc�kl� �� 47