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STATEMENT OF MORTGAGE OR CONTRACT INOEBTEDNESS
' F�JR DEDUCTION FROM ASSESSED VALUATION Coun 7ownshi Year
/ State Fwm a3709 (R5/4-03) . . � ! .
� Preuribed by Department of Loral Guvemment Finance � �
INSTRUCTIONS: � • ��
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is loca d
Filing Dates: 1) Real Property: Dunng the 12 months 6elore May 11 0l the year the deduction is e�9e '
2J Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 o/�ear fhe deduction Js to be effective.
See ieverse side for additional instnrctions and qual�cations. M/�R Q 6 2��6
Applicant
ucinq Distrid
contracf buyer-
side)
Key number / legal description
� � � � C —
Assessed value of real property as of Mortgage ! Contrad indebtedn
March 1, wrrent year March 1, current year
00 C�
I( no, what is his / her exact share of interest? If owned
If name on record is different than ihat of applicant, indiwte below:
of moAgagee or contred seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or
Address of assignee (number and sUeet, city, sfate, ZIP
Dra���er NO ...................
Card NO . .....................
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�
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", —�-F_ �u lZ�
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Signature
�hat counry?
GIBSON C�
Record number
Page number /r /' /�
,J b
as of Is lhe applicant, �th,en sole legal or
ownefl f�es ❑ No
T"
other than spouse, indicate with whom.
)ac.. ot�-7g�
Is the praperty in question:
�eai ProperlY ❑ Mobile
. .',? /5/
61.
What Taxing District? Has this dedudion been requested on
property for wrrent yeaR � Yes � No
COUNTY AUDITOR
zo �j'1 zo
P
County Auditor
20
20
Date
20
We certify under the penalty ot peryury lhat the above and foregoing informalion is true and correct and that the applicants was / were
residenl of Indiana a�d_owaer of lhe aforemenlioned property on March 1, 20
Person authorized by
or by IC 6-1.1-12-.07
,(,�r. y� � � �Address of aulhorized person
Attomey