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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
b µ� / Stata Fortn d3709 (RS / 4-03)
Prnscri�ed Ey De rtment of Loral Gov t F'
� pa emmen inance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ol the county where the property is located. � � � 2� 2�03
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year fhe deduction is to be e8echve.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year !he deduction is to be
See reverse side for additional instructions and qualifrcations. �� ��
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I Applicant (owner or contract buye�- see restnctions on reverse side)
Taxing
Assessed value of real property as of
March 1, wrzent year
If no, wnat is his / her exact share of interesl?
name on record is diHerent than that of
of mortgagee or contraU seller
Name of
of
Key number / legal description
l > >^ CJUoi l
Mortgage / ContraG indebtedness
March 1, current year
indicate below:
Record number
Page number
as of Is the applipnt the sole legal or
owneR �Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
or contrad seller (number and st2et, city, state, ZIP
or olher owner or holder of mortgage
of assignee (num6erand st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? I What Taxing District?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
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County Auditor
r� �',
i
Is the property in question:
�Real PropeAy ❑ Mobile Home (IC Cr1.1-�
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Has this dedudion been requested on
property for current yeaf? �] Yes � No
20 � 20
Date �
�/ We certify under the penalty of perjury that 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 1, 20
Signature (owners (ull name) Person authorized by duly executed Power of Atlomey ,
� � , �,��,� �„,_ (� ,� or by IC 6-1.1-12-.07
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F I resident a ress o( applicant Address of authorized person
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