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^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o s i Y r
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn C3709 (R71 / 609) .
� � Pfesaibetl M ceP��N of L.ocal Govemmerd Fnance
ie a
INSTRUCTfONS:
b 6e filed in person w 6y mail wiUr the CounryAUditor or Counry Recader o/ the counry where tFie pmperty is lorated. F
Fi(irg Dafes: i) Real Pmperty: Must file durirg the year for which Ihe deduction is soughL �J�� Coun A r
2) Mobile /ManuFadumd Homes rat assessed as Real Property Must file dunig the twefve (12J months CalB OK6AUNTY AUDITOR
6efore Ma�ch 31 of each year the deducfion is soughG LJ �nty Recorder
See reverse side (or addifionel instnictbns eM qualdicafrons.
a. ��Or. . �' /f(J0. �Y�—VO2 ! R ��� Pll�o��
v
A�essed vapie dreal7oPa�Y W �9a9e / Contraa irdrLtedr�s unpaid a d Mortgage / Contrart uWebOedness unDaid as d Is tlre aPP�� Ma sob
Me�U 1, cumit year Mardi 1, airteirt year Oate ot epP�� legal or equitade o«neYt
/ ❑ Yes ❑ No
n ro, whai rs na � ner eYaa share o+inr�t? rc amrea wim someorre «nm ma� . owrate wn, xMm
If name m remrtl a 6Rerent Nan Mat of aPP�4 uWipte bebrw Is the O�PeM in Ouestion: MnuePf Assessed
❑ Real Roperty � AfmuallyAssessed
rrotgagee «mntra�i seller
of nqrtcmce ar mntrad se0er
Name at assignee w
oo� aPw�v aN, wocenr
W�
county in Ind'ana? r
amount of
city, stgte. ene
�f'� /0-�-
`tiy, slafe, erd ZIP code)
Y�.
O. /��HG
I�I•P I: i �Z[�I�Ti [9:7
20_ 2�_ 20_ 2�_
�nanne W CmmtY Auditw Caunry
I/ We cerofy under the penalry of perjury Nat Me above aM foregoing infortnalion is f
owner / wntrad buyer of the aforementioned property on date application is filed.
�rew� n.hilnertiel // ' � _ .
JL_�
nA reylAenc atlNess of appfimnt (numDer antl sbcet �Y. �. and zIP ootley�
2.�0 9/-(/ S�� S-� �d lo /� �'�i�c
PersOn aW,w¢ta ey aWr e�a,tea awe. wnum,er «ey �c 61. -1 .�
Addrm of autlror'¢ed persm (numbereiMN strea; tlry, smle. arq LP mtle)
Rsr� � K -
�.n� M s�c,�
a�'�'�d�
I_"_ ` _ _' __.. ,--,
7 � o� p�,m, aar, r�J
m propelcy
❑ No
�