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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1� FOR DEDUCTION FROM ASSESSED VALUATION
'y .. ! Sta[e Form a3709 (RS I d-03)
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• PrescriDed by Department of Local Govemment Finance
INSTRUCTIONS:
To 6= filed in person or by mail with the County Auditor of the county where the property is located. ��� 1 1 20�3
Filing Dates: 1J Real Property: During the 12 mon[hs belo2 May 11 of the year the deduction is to be e/lective. ^'
2) Mobile Homes assessed unde� IC 6-7.1-7: Between January 15 and March 2 of the year th/e.deduction i/s to tie e�l/
S=e reverse side !or additional instructions and qualifications. {� ^ �S . 11_ „
3�o a� 3 � �SONC�OU+�YhUDITG�i I
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Tarzing
buyer-see
C� b3 �b3
Assessed value of reai properly as of
March 1, current year
If no, what is his / her exact share of interest?
ti� yq re� erse s� �/�,
II/ _ I �"� - �-
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Key number I legal description
W L '
Mortgage / Contract indebtedness unpaid as of
March 1, current year
If name on record is different than that of applicant,
of mortgagee or contracl
number
: number �) Q �'
( (J
Is the applicant the soie legal or
owner? ❑ Yes ❑ No
Ii owned wilh someone other than spouse, indicate with whom.
o( mortgagee or contract seller (number and street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own propeAy in any other I( yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 20 � 20
P��r ao �
IWe
� Real
❑ Mobile Home (IC 61.
��-y�
What Taxing District? Has this deduclion been requested on
property for current year?CI Yes❑ No
COUNTY AUDITOR
20
Counly Auditor
20
20 �� 20
P .
Date
fy under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
of India�aao�owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person