Mortgage_Moore (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION v
• Stata Fortn G3709 (R11 / 6-09)
�,w f Presaibed Dy Departmcrd af Loml Govemment Finance
� I F,,
wsrRUCnoNS:
b be fied in person or by mail with the CounryAUditw or Counry Recorder o/ the counry where the property is
Fitirg Dates: 7J Real Property: Must fila durng the year fir which Ne deduclion is soughG � nC,�o�unry Auditnr
2) 6efore Marc �co/ eeach year the dedeuclro� a�ghProperty: Must file dunng the tweNe (12) months FE p�? lFAunty Recorder
GOUNTYAUDROR
De�ucoon app�ovad In Ne amaum at
20 _ 20 _ 20 _ 20 _ 20 _ 20 20 _
SigreLae U Cmmry Autlrtor Counry Date (nmth. tlaY. Y��)
I/ We certify undu the penalty of perjury that ihe above aM foregoing infortnation is W e and correct and fhat the applirant is a resident of IMiana aM
owner / contrad buyer of the aforementioned property on date applicalion is filed. .
�6 (o hil name) Date (month. daY. Yea�
Fuil ' nt d d a irant m4er a stree4 �; �te, P codaj /\ � . ` "' `
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Pefwn aufhoi¢ed Dy duly executed Power UAnorneY a q' IC 67.7-12-0.7 Date (nmfi. Aay, yea�
Pdd�ess of aWwf'ved Pe� (number aM sbeeC �: sfate. antl LP rode) . � ' _ ' .,. _