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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S��� J State Fwm a3709 (RS / 4-03)
P25cribed by Depanment o( Local Guvemment Finance �
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INSTRUCTIONS: Fi e Mark
To be filed in person or by mail with the County Auditor of the county where the property is IocatedMAR 2 5 200�
Filing Oates: 1) Real Property: During the 12 months before May 11 of the year the deduction ' to 6e eflective�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March of the year t e dedu� ctio �� to e effective.
See reverse side for additional instructions and qualifications �"�'`�`�
'�' GI3SGN CGUi\ i Y AUD:T�' .
or contract
o�
C��Ns��//�
see
Assessed vatue of real property as of
March 1, current year
If no, what is his / her exad share of interest?
If name an record is different than ihat
of mortgagee or contrad
Address of mortgagee or contract seller
side)
Key number / legal d�cription Record number O,/
' %�'C %' O� /d��-� --�-
/ Page number �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, wrrent year owner? ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
indicate below:
�
m r and slieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Is the property in queslion:
❑ Real Property ❑ Mobile Horrie pC 6
Address of assignee (numberand street, city, sfate, ZIP code) � ...................
Drawer N ,/ /'�
Does applicant own property in any other If yes, what county? �% /,,,.���•' •" �n been requested on
county in Indiana? C3Cd N�• •""' � �nt year? � Yes� No
I
COUNTY AUDITOR
Deduclion approved in fhe amount of:
20 n,7 � 200(0 � 20 8_7__ � 20
County Auditor
� Y
�
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person