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^'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
_ + FOR DEDUCTION FROM ASSESSED VALUATION
�• Sfata Fwm C3709 (R71 / 6-09)
� f PresaibeE by �epartmerit of Lod GovemmeM Fuunca
INSTRUCTIONS:
To be fited in person a by mail with [he CountyAuditor or Counry Recorder of the county where the property is located.
Fting Dates: 1J Reai Property: Must file dunrn� fhe year Iw which tha deductlon is sought.
2) Mobde / ManufaUUred Homes not essessed as Real Property Must file d�ring the tweNz (12) marths
before March 31 of each year the deduction is sought.
See reverse side /or additional instnxGOns a qualilrcations.
Aoo5rant(owrermconlraCbww-see m versesd )
'�%���
A�ssed raNe c( real 7�Y as d
Mart�l� 7. aamla year
tt m. what is his / her eraa share o
Year
484b a,a�.
County Recorder
� � � oiesoN couNrv
r/ I descripUOn Rem�d number
� -�.� =i� - �QO. 9��-�a� ���
�ge/ Cantract indnbtednrss unpaid as W Monga9e I ContraU inAebteEness unpai0 az of Is th�
Mard� 1. wrteM Y� date of aPP��� , _ �
��urtie m �emrtl a Offermt tnan tnat ol aPP�
Name ot nprn�agee «mnirarl seller
��
Mdress of nartga9ee or wntracl se�er ( um6ar er
Name ol assignee or oNer awner or holAer af morq
Md�ess o( a:si9nee (numOer artl streef, tay, slefe.
Dces appiitant own poperty in any oNer
mu�uy in Indw�a? ❑ Yes ❑ No
Deductian approve0 in tlie amaunt of.
20 _ 20 _
ee{ crty, stafi, aM 21P code)
ZlPCOda)
���.�����
COUN'
20 20 _
Yes LJ No
Is Ihe P�7�Y in VuesOOn: Mm�eDy Assessed
❑ Real ProPeKY ❑ A^^�Y �
!, �:.��ssE1T G�R�S7oP �
x��y,� J�"'°'°°g'r
Yes ❑
aoti- gg�
Counry
20 � 20 � 20
I I We certify under ihe penalry o( perjury that ihe above arM foregning infortnalion is We and cortect arW that the applirant is a resident ot Indiare arW
owner i mntrad buyer of the aforementioned property on date application is filed.
Ifa4ue (ow�els 7utl �rtre) , ._ n � Date (monN. OaY. Y��
(number anC svee4 ary, sbte, antl LP cotle)
auNOrized Dy tluty exewced
person (number arM sbee; ciry. state, arM ZIP code)
`1� IVIY�. ... .
Date (monfi. tlaY• Yee�