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* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm G3709IR71 / 6-09)
,,�,� � Presaibad by DePa�M of Lod GoremrtreN Firance � �
i e Mark
INSTRUCTIONS:
F ih:
k be (led in person or by mail wiM the CounryAuditor or Counry Recolder o! the counry where [he property is locaf�'A
Fifing Dates: 1 J Real Pmperty: Must fJe duri�q Ne yearlor which the detluclion is sought � Counry Auditor
2) Mobde / Manufactured Homes not assessed as Real Property: Must Ae dunng the fweNe (72) montAs
before March 37 0! each year the deduction is sanghG � `�i7 �Counry Recorder
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SeeraversesideforaddiGOnalinsuuct�nsarMQUelfication� __..�ts wuo1TAR
�—crN..t�,.wt., i�av�-,�ra -� �- ._,�rx - ��v . i
w� vahie d mal aoa�r as d ge� ca,eati'ude6teaness unOZitl as w
Marh 7. w�mt Year 1. wrte�rt year
n�. Mrt,a� �� i�� �a y,are m��? rc�
tt name on 2md "s C'ittrJenf than Nat oi a0p�ant, hWifate belmK
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rlame a moneasee m m�caa seuer j/' � n
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Pddress oi rtprtgagee ar mnbad sWer (num8er and shaeG �: sfata. ard LP cade)
Name of assignee w oMer owner or halder M mM[
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Dp¢g gPptitan[ wm MoO�Y in any ather
counry u� Ind"ana? � Yes ❑ No
Deduc6on approved in iha amoum oY.
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p_ � 2p _ � 20 � 20
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What Tad`q7 Distria7
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I I We certfy under the penalry of perjury that Ne above aM foregoing infortnation is We and mn
owner / mntrad buyer M the ahxementioned property on date appliration is filed.
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IC 61.742-0]
(numDer an0 sfree4 �y, sb(e, and LP code)
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Yes ❑ No