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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
• FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
°. w� / State Fwm a3709 (RS I 4-03)
� PresaiDed by Department of Local Govemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the counry where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 months before May 11 of the year the deduction is to be eff.�ctive.. _
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea�r thie d`e'Idu`crf�ion isf';to be eT�K c�t/lve.
See reverse side Ior additional instructions and qualifications. }L g�/ ��J 1Lf
AUG 0 , 2003
Appiicanl (owner or nt ct buyer - see restnctions n rever side) �
<. � . �. �. D
Taxing Distrid Key nu r/ egal description � Recor 4. r0�� ^��, „3q�pi?On i
� O /d -�8-� 3a �� � �
, fr Q O' � 4� _� 0 Page number ��� t,
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Assesse value of real property as of Mortgage / Contract indebted ss unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year March 1, curtent year ��� � Q� owner? ❑ Yes ❑ No
/47oo�S
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home QC 61.7-�
�me of mortgagee or contracl seller
Address of mortgagee or conVad selier (number and street, city, s te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, cify, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has lhis dedudion been requested on
county in Indiana? property for current year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 20 20 20 �_ 20 0 20
��+a� p P P
Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correcl and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20 �
I Si ture (owners (u(1 name) Person authorized by duly executed Power of Atlomey
� � or by IC 6-1.1-12-.07
F esident address of applicant Address ot authorized person
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