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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
�. �u� ! State Form a3709 (R5/4-03) � .
� PfesaiDed by Department of Lara� Govemmem Finance
INSTRUCTIONS:
To be filed in person or 6y mail wkh the County Auditor ot the county whe2 the propeKy is locai��.
Filing Dates: i) Real Property: During the 72 months be(ore May 11 0l the year the deduciion is to 6e effective.pp p� A a@�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deQllctlo s7o ective.
See reverse side for additional instructions and aualifications.
�a� `��
Applicant (owner or contract
Taxing
Assessed value ofre:
MarcF� 1, wrrenl year
If no, what is his / her exact
nons o�rse
r� C
Key number / lei
desuiption � Record number
� Q� S �C' �3s S- �� Page number � a�
U
� as of MoAgage / Contract indebtednhss unpaid as of Is the appticant the sole legal or E
March 1, current year ownef? ❑ Yes � No
3��0�
ire of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan ihat of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or contraIX seller (number and sfreet, city, state,
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? I What Taxing Distrid?
county in Indiana?
Deduc6on approved in the amounl of:
20
Signalure
� ij'
COUNTY AUDITOR
20 � 20 20
County Auditor
I Is the property
LO Real Propeiiy ❑ Mobile Hane (IC 61.1-�
t �
Has this dedudion been requested on
property for current year? � Yes ❑ No
20
20
We certify under the penalty of peryury that the above and foregoing information is true and corred and that lhe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
nat/ur� (owners full na ) Person authorized by duly executed Power of Attorney
�"/_ . � �_ �._. 1 orbylC6-t.t-12-.07
Address of authorized person