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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCT�ON FROM ASSESSED VALUATION
State Form e3709 (Ril f 609)
Prescribed by Depanmem of Local Govemment Fina�xe
INSTRUCTIONS:
�,'�1'F'�!��'�
� `i � ..�s ��5.
e. • �
To be filed in person or by mail. �
Filing Dates: 7) Real Property: Mus( be completed and dafed in fhe calentlar year tor which the deducfion is sought.
Must be filed with fhe County Auditor or Counry Recorder o/ (he covnry where the property is locafed o ty Au itor
on or befo2 January 5 o1(he immediafety succeeding calendar year. ���� u o d r
2) Mobile /Manulacfured Homes nof assessed as Real Property: Musf file wifh fhe CountyAudiroi oI (he Gib on un y�ecor�er
counry where the property is located dunng the fwelve (72) months before AAarch 37 o/each year the
deducfion is sought.
See reverse side lor additional insbucfions and qualifications.
Gary L. Hancq
Tawng Disvict
Patoka �
hssessad value of re:
March 1.artentYear
105000.00
If no, what is his I he
II name on record is
bvyer - see reslric:ions on reverse sitle)
Key number / iegal tlasaip6on
26-12-09-103-000.172-027/Pt SW NW 9-2-10
ongage / Contract iMebledness unpaid as of Mongage I Con;ract
arch 7, arten[ year date af application
108000.00
share of interest?
t�at o( appGtant, intliwte bebw:
Name a7 rtrortgagee w conUaa seller
Wells Fargo Home Mortgag
Atltlress o( mortgagee or contract sep
owner or holder of rtar:9age
ciry, state, entl ZIP cotle)
slreet, firy, state, an0 ZIP code)
It owned wi;h someone olher Nan spouu.
Rewrd number
as
iitade ovmef/
Yes ❑ No
Is the property in question: Mnually Assessed
❑J Real PropeM Q MnuallyAssessed
Mobile Home (IC 6
Dces applicant own Oroperty in any oNer If yes, what wunry? What Taxing Distnct? Has this AeCUCtlon Gaen requested on properry
counry in Indiana? for curtem yeaR
n Ves No ❑ Yes ❑ No