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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�� �w� ! State Form a3709 (RS / 4-03) � � . . , .
� Pfescnbed by Depanment of Local Govemmeni Finance � �
INSTRUCTIONS � H , Fil M
To be filed in person or 6y mail with the County Auditor o( the county where the property is l�� �J ���
Filing Dates: 1) Real Property: During the 12 months 6efore May 11 0l the year the deduciion is to be eJfefrtiv,g.
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ theiY}e� tA� d���n is to be e/%ctive.
See reverse side for additional instructions and qualifications.
Applicant (owner or con ct 6uyer - see restnctions on reverse si ) G
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Taxing D� rid Key number / legal description Rewrd
Assess�value of real property as of
March 1, wrrent year
If no, whaf is his / her exact share of interesl?
� O L/ _ � I� ,r,� Page number
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Mortgage / ContraU indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year owneft ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below:
�me of mortgagee or contrad seller
Address o( mortgagee or contrad seller (number a treet, city, state, ZIP
Name of assignee or other owner or
of assignee (number and st�eet, city, state, ZIP code)
Is the
❑ Real PropeAy O Mobile Home (IC 61.
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Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis deduction been requested on
county in Indiana? property for current yeaf? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 2� _O_� 2� _L 20
P ,� �
Signature
County Auditor
�
20
20
certify under the penaity of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March t, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person
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