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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ + FOR DEDUCTION FROM ASSESSED VALUATION
- • Stafe Form C3709 (R71 / 609)
,' w. f PreunbeE by DepartmeM of lxal GovemmeM Fnarce
.ile lark �1
WSTRUCDONS: �
F Nedwrth:
To be filed in person or by mail wiN the CountyAuditor or Counry RecoNer of the counry where the pioperty is focated. E �p / i��„�
Fitirg Dates: f) Real Property: Must fde during Ne year for whicA 1he deduction is soughL �� unry Auditor
2) Mo6de / ManuFactumd Homes rat assessed es Real Property Must f+le dunng fhe fweNe (12) months County Remrdu
6efae March 31 of each year the deduclion is sought. �jlQ
See reverse side (oraddit�nal instrucGons and qualifications. GIRC ��
�AmG�ani(ownerar huuer-see�d,:��:.,��m ' l ��� AllAltr.e �
������� !A0r(q3g
Mart3i 1, amn[ yCdr MarCh 7.
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11 no, what a tds / her erad share of intrsest7
tl name m iemd is Q�Iternnt lhan that af aPp�ant hMirate bek
Name of mortgagm v contract seller
ACdress d rtiart0agee or contrap sWer (nvnbe� and sLee; -
Namn M x�.e...,....._ "'"_ _'.�.__ _` _"""— _
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Dra��•ci• NO..°.? °./d.........
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��'3!0 30� -DOo�- �l-?3 d� P�e��
;htetl�s unpaitl az W Mortgage I Con7aa uWebtedness unpaiE as Is Ne eppraanl the sde
data M ePPfxatqn kgal W equi1a61e awnrll
�OO� ❑ Yes ❑ No
if awneC with someone other than sP�+�. Gd'Kate wRh xlrorn
Is ProPert1' in Ouestion: Mnus%Asc�seE
Real Property Q Afmua�hJ ASSessed
�1. /1 Mobile Flane OC 61.1-�
arcl ZIP"code) \ - �
unt/1 WhatTadr
COUNTY AUDROR
20 _ � 20
Caunry
.Vict7 Has U�is tleduUim Eeen re9ueste0 m propeny
fm wrtent yea(?
❑v� ❑�
20 20 20 _
n
�.-t�-����,�.�Y.� ,�
that above and foregoing information is W e and cortec[ and fhat Me applirant is a
ned rty on date appiication is filed.
saee(.
state,
w by IC
of I�iana and
daY. Ye�