Mortgage_Arnett^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship vear
:.°—
FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 0.3709 (R71 / 609)
�' Presaibed b9 OepartmeM o( Lool Govemment Frence
� File Mark
INSTRUCTIONS:
���
To be filed in person or by mail wiN the CountyAuditw o� Counry Recorder ot the county where the property is locat�
Fiing Dates: 7) Real Property: Must file duri�g the year (or which fhe deduction is soughL p,� ��
2J Mo6de /ManulacN2d Homes rrot assessed as Real Property Must file dunng Ihe fweNe (12) month
befwe March 31 o/each year t/ie deduction is sought. �
See reverse siAe (or addiGonal instmctans and qualificafions.
App6reni (owner G by+r- see verse side)
C.�. •.
Key nunba / legal desaiGtirn RemN Der m
_ o - -ao - d
vdlue d real qoperty az of M�r(pyge / Contraa'udehtetlness unpaid as o( Mongage I ContraG indebtetlness unpaid as ol Is ihe eppl{rsnt Ne sole
'/arM 1. amerLL year Mard� 1, w t Eate o( eOP�� legal w eQuipble owneri
� ❑ Yes ❑ No
If ra, wfial's his / tcer emG share o( interest? tl aw�d wi� someone aher �han spouse, i�icate wifh winrn
If name m �ec«A a diRem�t than that d appliran; i�Mipte Delow: Is the property in QuesUm: Mnua�y Assessed
: %� (3 ��m �a,,,�ya�
n�ae�ne ic��.�a>
Name N mort9a9ee ar mntract se�er \
Address of mortga9ee ar contract sWer (num6er arM street, cdy, sfate, aM ZIP code) � \
Name of assi9nee w aNU ovmer or holder d mortgage \
AAGress ot assignee (number and shee4 �Y. sfate, aM Z/P cotle)
Oces aPpiimm own propGty in any oNU I( yes. whal counryt What Tari�y DisviC ��equ�teE m prope�ty
county m Ind"ana? ❑ No \ � Yes
❑ Yes ❑ No
� �
COUNTYAUDROR \ �
D¢tluGtiOn apyoved'of �he amouni ot \
20 _ 20 _ N1 20 20 �� 20 _ 20 _
Sig�W2 N CowN Auditor Counry Date (moNh. EaY. l'��
1/ We certify urWer the penalry ot perjury N the above and foregning infortnation is We antl correct ark Nat the appiinnt is a resident of Irnfiana aM ��
owner / contracl buyer of h foremeMio property on date applicatlon is filed. �
Date (monm, day, yrea�
Sigra efs futl n �
Fill t at a t(numDe� a sfreet o�}; state, and LP ootle) '
auUroraed Dy tluty executed Power of Avomey w by IC 67.1-12-0.7 Datc (monN, day, yEa�
P4dre55 of auNor¢ed person (numbe� ard streeG �: stale, an0 LPCade) . ��