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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�2te Form a3709 (Ra / 70-07)
Presaibe0 by Depanment ol Locai Gevemm_nt Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail wifh fhe County Auditor of the county where the property is located. � AN � 2��3
Filing Dates: 1) Real Property: During lhe 12 months be%2 May 11 oJ the year the deduction is to 6e effective.
2) Mo6ile Homes assessed under IC &1.1-7: Befween January 15 and March 31 of year the d on is t e ective.
See reverse side lor additional instructions and qualificatlons.
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Applicant wnerorcont ctbuyer- restnctions rev sid
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Taxing Distrid Key number / al description Record numbe� �
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Assessed vatue of real property as of MoAgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, wrrent year March 1, cunent year /Q� �Q owneR ❑ Yes ❑ No
If no, what is his / her exad share of interest? I owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home QC 6�1.1-�
me of mortgagee or contrad seller �
Address of mortgagee or contrad seller (number and sfreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Dces applipnt own property in any other If yes, what counry? What Taxing Distrid? Has this deduc[ion been requested on
county in Indiana? property for current yeaf? Q Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing informalion is true and corred and thal lhe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
nature (owners /ul name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F II resident address of applipnt Address of authorized person
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