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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
> J State Fortn a3709 (RS / 4-03)
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� PresaiEed by Department of Local Govemmeni Finance
INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the County Auditor of the county whe �the propeRy is lo�y� ���
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction b If tive.
2) Mobile Homes assessed under IC 6-1.1-7: Between Janua 15 and March 2 o Ae r e e/fective.
See reverse side for additional instructions and qualifications.
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ApplicaM (owner o! on c( buyer- see restdct ons on rqvers ide) ��
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Taxing Disirid y number / legal escription R um er oS
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Assessed value of real property as o Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exad share of interesl? I owned wilh sameone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Home (IC 61.1-�
��e of moAgagee or contraIX seller
Address of mortgagee or contrad seller (number and sf2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, 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 curtent yea(? Q Yes ❑ No
COUNTY AUDITOR
Deduction approved in lhe amounf of:
20 20 20 20 O 20 20 20
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Signature Counfy Auditor Date
We certify under the penalty of perjury thai the above and foregoing information is true and corred and that lhe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
S' nature (o ers full name Person authorized by duly executed Power of Attomey
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or by IC 6-1.1-12-.07
F I r ident ddress of applicant Address of authorized person
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