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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION u o ns Year
� �� � ! Stace Form a3709 (RS / a-03)
� PrescnEetl by Departmeni ot Local Gdvemment Finance
INSTRUCTIONS � �-y„� � �ile Mark
To be filed in person or by mail witb t6e CountyAUditor oltbe county where the property is located. ���� �Y��
Filing Dates: 1) Real Property: During the 72 months be/ore May 11 of the year the deduction Q����Y AUDITOR
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See �everse side /or addilional insfructions and qualificalions.
Applicant (owne� orygntrac! buyer
Taxing Distrid
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on reverse
/ legal description
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Record number � �
Page number / /
Assessed value of real property as hf/ Morlgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current r owner? ❑ Yes ❑ No
� �
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than thai of applicanf, indicate below: Is lhe property in question:
of mortgagee or contract seller
Address of mortgagee or contrect seller (number and
Name of assignee or other owner or holder of morigage
city, state,
■ '-• ' ••-.�.
❑ Mabile Home (IC 6�7.
Address of assignee (number and street, city, state, ZIP code) ��.{ 0
Drawer NO•�•• Y^"
. _.; �
Does applicant own property in any other If yes, what county? What Taxing Distrii �� 7� ._,,,,.
Ca O. ..':...........
county in Indiana? rd N
COUNTY AUDITOR
Deduction approved in the amounf o(:
20
Signature
20 �Z
20 Ub 20 �_ 20
P P
Couniy Auditor
20
Date
20
We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 7, 20
Person auihorized by duly executed Power of Attorney
or by IC 6-1.1-72-.07
�� � Address ofauthorized person
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