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^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou own ' ear
__,. � FOR DEDUCTION PROM ASSESSED VALUATION
State Form C3709 (R11 / 609)
�� � Prcsaibed by DeP��ril of Local Govemrtrertl Firetce
M ��
INSTRUCTIONS:
To 6e filed in person w by mail wrN Ure CountyAUd'Rw or Counry Recorder of fhe county whe2 the pioperty is locafed.
Fi/ing Dates: 1J Real PropeRy: Must file during Ihe yea� /or which the deduclion is sough(. � ��
2) Mobile / Manu/actured Homes not assessed as Real Property Must fiie dunng the nveHe (72J months ,l�� ���p 170R
6etore March 31 oleach yearthe deduction is sought G�gS N V�'�^tyrcemrder
See reverse side for additional instnictiuns aM quali�cations.
Aoofrant (ow�m.r or convactbuver - sea resMrlbris m 2verse sidel
ea r�ue d mal papeny as of
1,fiprent�
m
ot rtnrtgagea « mnbaG seller
er / legal drsaipHm
-I(-15:3Q'�
nwr�qaqe i cmaaa �
Ma�d� 1, curtenJ.yeeL
ot rtnrtga9ee or contraa se�er Inum6ra and sheet. ciry, sfate. aM ZIP code)
name a� assry�ee w ouia ownei
snce4 �: slate,
wm property in anY oNer I If yes. whal count�+
a?
� ❑ Yes , ❑ No
Deduction approveA u� ihe
20 _
sy�nne w co�mH nuertor
� � �
num6er � Page numbrl
as N Morlgage / ConvaU'vdebtedness un7aid as d Is Ne aOP�t Ne sde '
date of appfrcation @gal w equilade �
❑ Yes ❑ No
' awned wiN wmew�e ottrer tlan spouse. irMkste wtth wlm�
�l :7 )Y�t !\'�
_ Ca!'c/ �VO
NTat Taxn.y
)UNTYAUDROR
20 20
Is Cie property in Question: MnUaDy Assesud
� PmPeM ❑ /4mually Assessed
Modle Home QC 61.
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� �uestetl m P�P�Y
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20
I/ We certify u�u Ne penaly perjury t the ve arM foregoing infortnation is We and cortect and that the applicant is a resideM of Intliana aM
ovmer / mn yer of the oreme � ed p rty on date application is filed.
�re s GAI reme) 6dte (month. dey, yea�
r
'entaAdrassWapplidntl ra sLaef. sbte ZlPmtle)
- /aSo �. ��0 1.� �-�n� �-. �/✓ 2/y� 70
rson autM�d by dWy ezecvtetl Powel a( A[tm�ey w by IC 61.1-12-0.7 �ate (monN, Cay, yxa�
Pdtl� d auGw'ved puson (number aM sbee; riry, state,