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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
:• Stata Fortn C3709 (R77 / 6-09)
�,,,, � Presai�eE M OePa��m of Local Covemment Fumnce
File Mark
wsrnucnoNS:
To be filed in person or by mail wiM the CountyAuditor wCounry RewNer o� the counry where the properry is located.
Filing Dates: 1) Real Property: Must fJe during the year for which the deduclion is sought.
2) Mobde / Manulactured Homes rwt assessed as Real Prt�pefty: Must fiie dunng the hvelve (72) months
befwe March 37 of each year Ne deduction is saght.
See reversa side for eddiWnal instnictions end qualificatrons. �, �
Anofral(a(owrer or convaC 6u�e� - me restriraoas m reyrrse sidel . l .
Asrss� rahie d real P�Y as ol
AIa�U� 1. arrenl Year
nm6er I le9al dewiptim "
>(n-1$-l3-`{aa.-DoD• 1�0-0��
�M11ortpaga / Contraa irdehteEness un0aid as d Mortgape / Contraa hdebtedness
March 1, artentyear Eate of aOP�ption
It nq what 6 h'a I hu e�1 share ot internst?
H narne m remN ia dtlferent Nan that W aOW�^4 mdic
�
���,�a���� �,-
�ear�ss m rtnrya9ee or ca,tran sr9er (num6er e,d str
Name ot assignee w omu owner or holder of rtqrtgage
AdC`ess ol assignce (number ard SCeeS �Y• stete. and
Does applirant ovm poperty in any oNer
munry v� Indvna?
n Yes ❑ No
It wmeC with mmea�re
U co��ryrwd�to�
a�� Recorder
aSON COUNTY AUDITOR _ _
R¢rnrd number Page numCer
��a�� ��a����
Iegal n epuitade avrtren
❑ Yes ❑ No
- -__I.IS Me Wope+ry m aursbon: MrweOy assessed
. _ - ._.,r14+muallyAssessed
v,������,- �vo. a.oi o _.....
ray,sbre.aMLPcode) • C�71�CI
1�'�. 0�,0�'�'J,......,
�) �iM1/ ti'tir""",,F'v il/ � � �
s. what cauniyl W�at Ta�drg Distrirll (� �� Oeen ^uestsE m p�operty.