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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION
S j State Fortn a3709 (Ra / 70-01)
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Prescribed by D¢partment of Locai Govemment Finance
Year
INSTRUCTIONS: �ile , a
To be filed in person or by mail with the County Auditor of ihe county whe2 the property is /ocated.
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 of the year fhe deduction is to ��feqfj�� a
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year fii Hbn is to be effective.
See reverse side (or additional inshuctions and qualihcations. � �%1 „ „
IPniMEant(fl�•^�'�cont e - e /
�azing District `
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Assessed value of real property as of
March t, wrrent year
If no, what is his / her exact share of interest?
Key nurrfber / legal description Record number �
VD�� �s1G �� 8� Page number h�
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MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year owneR � Yes ❑ No
If name on record is different than that of appliwnt, indicate betow:
If owned with someone other than spouse, indicate with whom.
of mortgagee or contrad seller ✓ I�
J
>s of mortgagee or conVad seller (number and street, dty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
approved in the amount of:
20 Q,�
Signature
20 � /j_
20 �2 20 �� 20
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County Audilor
Is the property in question:
❑ Real Propc�ty ❑ Mobile Home pC 61.
Has this dedudion been requested on
property for curtent year?� Yes� No
20 �
Date
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i
We certify under ihe penalty of perjury that the above and foregoing infortnalion is true and corred and thal ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�natu owners full na�e�, Person authorized by duly executed Power of Attorney
�„_ J �J „� or by IC 6-1.1-12-.07
�nt Address of aulhorized person
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