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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS � Coua
__ : POR DEDUCTION FROM ASSESSED VALUATION �
• Sbta Fam G3709 (R71 / 6-09)
S ! PresrnDed Ey De7a�rd of Lo�al C»vemmerit France
INSTRUCTIONS:
To be filed in person w by mail with the COUntyAuditor or Counry Recorder oI the wunry whe2 Ne property is located.
Filirg Dates: i) Real Pmperty: Musf file dunrq Ne year /or which the deduction is soughf.
2) Mobde / ManuFactured Homes rrot assessed as Real Property Must file dunng the twelve (12) months
before Ma/ch 37 0/ each year Ne deduc7ion is snught.
See reverse side tor additional insVUCtions and qualfications.
�DM�^Ylowryr,orconvartquyyr-seelesMctiarswye�ersevde) n ' . �
Y rnal pioperty as
Y�
—Q�— CLEC.EI• OS — 4
ntraa rtWehtedn�.s unpai0 as d Mat9age / Con:rx
nt yeer date of appGCation
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tl name on femd is Oilferent Nan that ot aPP��I ���e Eeb'�'
Name of mortgagee ar mnaaa se4er � ( �
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Atltlress of rrortgagee w mntracl se0er (numbu and t, c. state.
Name af asvgnee or othr! avmer w hdder of mortgage
Daes eppircaN avn paperty in any oNer
munty in Intlana?
❑ Ye5
Deduction app�wed N ihe
slafe, and 2/P cade)
tl `�es. what
unpai0 as at
� � ��
nty AudiNr
1.�
epyiwit the sda
w epuilade mmeR
nY� ❑No
Is Me p�operty in Quatim: Mnually Asscttetl
❑ Real Property ❑ MntWlyAssessed
hbW1e Fipne fIC 6
No � I �I]�n
COUNTYAI_ DI�$\�'L'I���...�7�:.5.......
c�ra ��o. ....�?�13........
iproprny
2q _ 20 20 _ 20 _ ' _
� c� 5, �q► . 59
�n� w ca,�n a,e�r� c..
I/ We certify under �he penalry of perjury that Ihe a6ove aM (oregoing infortnalirn is We and cortea and Nat Ne applicant i5 a resident of Irdiana arxf
owner I contract buyer ot ihe aforemeMioned pro n date application is filed.
Inanve (oxp�YS hA Date (montli. daY. lea�
� /Lri, ,��. �..�- -
state, an?ar od
ry I 61.1-12-0.7
Pdtlress of aWmrtred person (number arM sbae; Wy. sfate,
Date (rtanlh. OaY. Y��i ' '