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"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_. FOR DEDUCTION FROM ASSESSED VALUATION �
State Form C3709 (R77 / 6-09)
1 y„ PresaiCeE by �eD��rd oi Lool Govemmeiu Fi�nce
INSTRUCTIONS: � �
b 6e filed in permn or by maii with fhe Counry Auditor or Counry Recorder o/ fhe county whera the property is located. J� �� Q
FrTmg Dates: 7J Real Property: Must file durirg the year hr which Ne deducLOn is so�qht � Counry Auditor
2J Mo6ile / Manufadured Homes irot assessed as Real Property Must file durirn� the tweHe (12) months
befwe March 37 o/each yearNe deduction is soughG �, ❑ nty Recorder
See reverse side /or additional in57ructnons end qualifications.
(mmeiarconaac6uyer- rastrcla�smre.ersesee) • ON COUNTY AUDITOR
/,� ' a.r...��eJ� _ Gc��,FQ,c�
`r�� oisv;a Key � kqal aesaiption aewid ru,meer aage �u,mbe.
:z�.,/ r.�r �/�-b-3/_.3D'f-ODO. �oQ-oo9 a.0/D a�Zr
�
If no, what
tl �ama on
m
Nama M rtrrtgagee or cmtract aeiler
�
/�dOress of nnrnja9ee m m�VaU se0
Name of assi�ee w otlw ovmer or �
Intl�na?
De�uNrn aPD�� In Ihe
any otlur
Yes
uR uWic2te Eelo�r.
� 1
r and stroet �Y. s
qrtcjage
ete, apy LP catle)
��-�. ;
��
No
cy� i cdmaa meeccea�s �,v� � or � n� �W�c are sae
; ot app�cation � «e�utrahle a•+re/?
❑ Yes ❑ No
saneane otl�er aian spouse. u�d�te witti whrnn
is ipE praperty in Guesfiar� M�waOyASSes.ed .._
4JReaIPmPenY ❑!?��!WIYA�s�
c.�.� y68
NT2t Ta�on9 D"6b
COUNTYAUDROR
9 Y7�
Fi2s Na tledutCOn Eeen requested an pfoperly
For tunerLL YraR ❑ Yes ❑ I
2p _ 20 _ 20 _ 20 _ (,J �'"�"' f-{.C�C�i �'� Ic-C.L..i � _
W Z�-�'"`5 � DA,�i� �lC f�
I�medCamtYAWitw � CaunN ,� /�L� r.��v �IL
W �/
I/ We certify under Ne natty of perjury Nat e above aM foregoing infwmalion is true e .�,! D/ U a���
owner / contracl buye� ot the aforemerrooned properry on date application is Aed. V�
i (ownefshID ) ' vrimm.aaY.Y��)
�aru�.�+ N � ccs-� �u-�QQ�-c,�-� (�
0 resltlent atltlmss W app0�ani (number antl streaf, �; smte. anE LP oode) , ..
Soukh 4r" Av� Haub:
utla�aed Ey dury exeated Porer of Atmmey w q IC 61.1-7T-0.7
d aWw'vetl G� (numberaid s8ee4 utY. sbta. end LP cotle)
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