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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 93709 (R71 / 6-09)
� 1 Presaibatl M DeGarnreN of laal Go.emment Finance
INSTRUCT70NS:
with:
To 6e filed in person or by mail with the CowlyAuditw or Counry Recorder o/ the counry where the property is locat� N 2 �
FiNng Dates: 1J Real Properry: Must file dunrg the year lor which the deduction is saught �l�—C",ounry Aud"rtnr
2) Mo6ile / ManufacNred Hwnes not assessed as Real PropeRy: Must fi7e dunng the fwelve (72) moCth3�
before March 31 of each year the deduclion rs sought. Counly Recorder
See ie e side / addifional instnictions a�a/ifications.
0
ro.
I7 name on 2cpC'a dAfurn� tl�an ihat of appBraN, rtdimta Eelmr.
Name of mM8a9ee v cmtrart se�er
Mdress of rtartga9ee u contraq
�
�-070/-�O.(n�8-0o� I
LteCness unpaid as af Mortgage / Contrart udehtedness
� . date of appOcation
cdy, sta:e. aM ZlP oode)
Dce5 appliUN a+m Gro7eM`/ in arry d�er 1' q what mun[yl
munry in Intlana? ,
❑ Yes ❑ Nr �
Draucaon e7W� in Ne amou� ' ��V� � —
20 � � �
�,re� � �,�i� a�o �
�, WE �� p�� � a���
owner i. � .� property on date a
�
cM,�,� r�.W.. , i . i
�
Pn�son auNOi¢eE Gy tlury e.
persm (number aM SLeeR c% sfate, end LP code)
INTat Te�drg Dsbic�7
COUNTYAUOROR
20 20 _
ca,�h
ing infortnation is true and wrtecl and
�iication is filed.
spousa.
Remrt1 number Page
�U1 /
Is Ne applksnt tlia sok
kgal or equlta6ie owneR
❑ Yes ❑ No
Ls ttie ProD�Y in Gu85con: Mnu80y AssesseO
] Reai �aenr p nm,�ny �o
Has Na detlumon been requestetl m propelty
tor cunent YeaR ❑ Yes ❑ Na
20 20 _
��c��.�
�—d8-1�
at the appli�ant is a resident of Iridiana and
oate (month. dar, reaA
7G�0
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