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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION - 7oG((i��nship'�"`; Year
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� �� / SHte Forrt; d3709 (RS / 4-03) {�� . �^
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� PresaiDed by Department of Local Govemment Finance
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INSTRUCTIONS: ile Mark
To be filed in person or by mail with the CounryAuditor of the county where fhe property is located. � •
Filin Dates: f Real Pro e Dunn the 12 months before Ma 11 0/ the '' """' ����
9 I P�Y� 9 y year the deduction is to 6e e�c\G'tive .:G��r i Y AUDtTC': .
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yearTfie de`duction is to 6e eflective.
See reverse side for additional instructions and qual�cations.
Applicant (owner or
Taxing Dislrid
buyer- see restrictions on reverse side)
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number / legal description I Record number
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( Page number
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? �es ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicanl, indicate below: Is the property in queslion:
of mortgagee or contrad seller
of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what counry? I What Taxing
counry in Indiana?
Oeduction approved in the amounl of:
20 �_ 20 �J �
Signature
COUNTY AUDITOR
20 � 20 �g_
Y 1
County Auditor
Property ❑ Mobile Home QC 61.1-�
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DrawerNO. � ..:............ 7 No
CardNO . .........:...........
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Date
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/ 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
full
resident address ot applicant
( O S �a,w�o S q �(
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address of authorized person