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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -- —
FOR DEDUCTION FROM ASSESSED VALUATION i': . Coun ?� T w hip Year
�'+ / State Fortn a3709 (R5/4-03) - � � . . � . � � �
.«• -- , , • ' - . '
� Prescri�ed Dy Departmeni of Local Grivemment Finance � � � � ��
C�.� s
INSTRUCTIONS: " ' Fi Mark
To be filed in person or by mail with the County Auditor o/ the county where the property is located. '�f"� '��
Fifing Dates: 1) Real Property: During the 12 months be%re.May 11 olthe year fhe deduction is Lo�be e((ec,�Yiyg��iY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7:, Between January 15 and March.2 0/ the year.the deduction is to be eNective.
See reverse side for additional insfructions and qualifications. �
(owner or
District
se�'ntACtiops on verse sic e)
wti F
Key number / legal descripti
� ��—d/,�d�' �O
Assessed value of real propertJ as of Mortgage / Contract i�
March 1, current year March 1, current year
9�
If no, what is his / her exact share of interesl?
If riame on record is different than that of applicant, indicate below:
of mortgagee or contract seller
Address o( mortgagee or contraIX seller (nurtiber and st�e° -- et, city, state
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
number
Page number
unpaid as of Is the applicant the sole legal or
�� o�, owneR ❑ Yes ❑ No
with sotneone other than spouse, indicate with whom.
s the property in question:
❑ Real Property p Mobile Home (IC &1.
I--��
Dra trer 1�.� �/ � ,
Car� `;O '�o , ./ ��i
What Taxmy �., • �on been requested on
rent yeaR� Yes� No
COUNTY AUDITOR
)eduction approved in the amount of:
20 �_ 20 _Q� 20 �� 20
o a P
SignaWre
County Auditor
20
20
�
certify under the penalty of perjury that the above and foregoing information is true and corred and ihat the applicants was / were
lent o( Indiana and owner of the aforementioned property on March 1, 20
ire (owners full nam Person authorized by duty executed Power of Attomey
;� .,_ p_ S' �� �"- or by IC 6-1.1-12-.07
address of applicant Address of authorized person