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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION _Coun 7ownship Year
�'• � � / State Form a3709 (RS / 4�03) , � A
� P2scriEetl Cy Department ol Lora� Govemment Finance ; tl�,,,/
iNSrRUCnoNS: JUN 0 g 2006
File Mark
To be filed in person or by mail with the County Auditor ot the county whe�e [he property is located.�-.
Filing Dafes: i) Real Property: During the 12 months be)ore May 11 0/ the year the deduction is to be eHectii2 �
2) Mobile Homes assessed under IC 6-L 1•7: 8etween January 15 and March 2 at,�lte.year�th�e��eyd�t��o 6e eHective.
See reverse side for additional instructions and qualifrcations.
- see
Taxing Disirid
�: ' .
f
AssessEd value of real property as of
March 1, wrrent year ,
If no, what is his / her exact share of interest?
on"reverse side)
Key number /
Record numb � — �
Q /�/'_ �Q( •i / = � Page number "" -. --
l � �O
MoRgage / ContreU indebtedness unpaid as of Is the applicant the sole legal or e
March 1, current year owner? �es ❑ No
J� �o? DOO� � .
Ii owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicanl, indicate below:
,
of mortgageepr �gntrad seiler
Address of mortgagee or contrect seller (number and st2et, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
Does applicant own property in any other I( yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 � I 2� _v �
�
Signature _
What Taxing Districl?
COUNTY AUDITOR
20 6 � 20 20
�
County Audilor
question:
� Mobile Horne
Has this dedudion been requested on
property for current yea(? � Yes � No
20
20
certify under the penalty of perjury that lhe above and foregoing information is true and corred and that lhe applicants was / were
'.ent of Indiana and owner of the atorementioned property on March 1, 20
re (owners full name Person authorized by duty executed Power of Attomey
�jy� Q � � ��� orbylC6_t.t-12;07_
of applicant (fW �l S J��( ddress o( au�orized person
?�d�7 �d�8o� ��