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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S J State Fortn a3709 (RS / 4-03)
�«
� PiesaiEeO Gy Department of Local Guvemment Finance
INSTRUCTIONS: � � �Ie M�
To be filed in person or by mail with the CountyAuditor o/the county where the propeRy is located. � ��
Filing Dates: 1) Real Property: During the 12 montbs be(ore May 11 of tbe year the deduction is to be eHective. �"
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the��uc�i'on is��Obe effective.
See reverse side for additional inshuctions and qualifications. /-` � 4
Taxing
81 _.. ::Ihd� Y
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description Record number
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Assessed value oi real pro�ertv as.of Monnann`i cnntrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrei E L`�,ll M p� K/} ,�,�/J owner? � Yes ❑ No
�� pA,�.tEL S )E`�"d
Ii no, what is hi ' owned with someone other than spouse, indicate with whom.
03 - I i o�k 0
If name on recc
mortgagee or contrad seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address
and at2et, city, sta[e, ZIP code)
Daes applicant own property in any other I If yes, what counry? �� What Taxing Distrid?
county in Indiana?
Deduction approved in the amount of:
20� 20 20
Signature
COUNTY AUDITOR
�
County Auditor
20
s the property in question:
❑ Real Rroperty ❑ Mohile Hmie pC 6�1.1-
Has this deduction been requested on
property for cunenf year? � Yes ❑ No
20
Date
�
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature
Person authorized by duly executed Power of
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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