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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION C'
�+ ! State Form 03709 (RS / 4-03) � . . . - ,
PrescnUeA Ey Department of Loral Govemment Finance
�
� INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the counry whe�e the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 of the year the deduction is to be
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ye
See reverse side for additional instructions and quali�cations. �
Applicant (owner or contracf buyer- see iestrictions on reverse side)
Distrid
Assessed value of real property as of
March 1; wrtent year
If no, whaf is his / her exaci share of inierest?
If name on record is different than that
of mortgagee or contrad
number / legal description
p � � _ ��•
Morlgage / Contred i�
March 1, wrrent year
indicate below:
� File Marli �°
�C� ii C 2�04
ective)
tbe deduction isto be eHective.
number
Page number
unpaid as of Is the a
owneR
If owned with someone other than spouse,
or contraIX seller (number and street, city, state, ZIP
Name ot 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 I If yes, what county?
county in Indiana?
20
Signature
approved in the amount of:
20
Taxing C
COUNTY AUDITOR
20 20 _� 20
Q P
County Auditor
Is the property
1``` ��/i��'h���e sole legal or equitable
�es ❑ No
idicate with whom.
�uastion:
� Mobile Home QC 61.1-�
Drawer NO. F,o„�, ,�. .. ... ,
CardNp ,_ !rJ�SS
�.on pQ�,y�� ......
�i
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20
Date
20
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
�sident of Indiana and owner of the aforemenlioned property on March 1, 20 �
nature ners (ull �am Person authorized by duly executed Power of Atlomey
� AD.� �.�� � n�ia,,,, � 0 0� by ic s-i.�-iz-.o�
of authorized person
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