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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION n To ip Year
r, ti• �w ! State Form <3709 (R5/4-03)
!� PrBSCnDeE Dy Departmeni of loral Govemment Finance
05
INSTRUCTIONS: �–�y� ile M�
To be /iled in person or by mail with the County Auditor of the county where the property is located. p'��
Filing Dates: i) Real Property: During the 72 months before May 17 of the year the deduction is to be e/le t�y NCOUNTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1 •7: Between January 15 and March 2 0l the year�%i� �duction is to be elfective.
See reverse side !or additional instructions and qualifications.
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Applica owner r contra t buyer - s restrictio on reverse side) Q
O O
Taxing DistriIX Key number f legal description Record number
c
QQ � ^�O � 7 _ � Page number
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as o( Is the applicant the sole legal or equitable
March 1, curcent year March 1, wrrent year owner? �s ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different Ihan that of applicant, indicate below: Is th property in question:
eal Property ❑ Mobile Home pC 6-1.7-�
�me of mortgagee or contract seller
- os- a933
Address of mortgagee or contract seller (number and st�eet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, slate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year? � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 20 i� 20 20 20
P P P
Signature County Auditor Date -
�/ We certify under the penalty of perjury that the above and foregoing in(ormation is irue and correct and that the applicanls was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Si ature (o� name) n Person authorized by duly executed Power of Attorney
�� or by IC 6-1.1-72-.07
Or�<�
Fuil resident address of applicant Address of authorized person