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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION �od'n .—r T ns p Year
L�w� ! Siate Fwm a3709 (R5/4-03) � - v
� Presaibeo Oy DepaRment of Loral Govemment Finance .
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INSTRUCTIONS: �-y� � F��'le, Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. 0"i6 �
Filing Dates: 1) Real Property: Dunng the 12 months 6e(ore May 11 0l fhe year the deduction is p.b�e�ej/�e1TY AUDITO�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/��e° year the deduction is to be eNective.
See reverse side /or additional instructions and qual�cations.
Applicant
Taxing
/
6uyer
on ve e side)
Key number / legal de cord number
,�l-/o?-a2ota3- • G� oa1?
Page number
� '.� . -V
Assessed value of real properiy as of Mortgage / Contrad indebtedness unpaid as of Is the applicant h ole legal or equitable
March 1, current year March 1, current year owner? Yes ❑ No
�� �
If �io, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the operty in question:
y ❑ Mobile Hmie (IC 61.
moAgagee or contract seller
Address of mortgagee or contraG seller (nuru�er and sf2et, city, state, ZIP
�%
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code) .
Dra�veri\'O. o� _ ,s-
...........
Does applicant own property in any other If yes. what county? Wh � "• � quested on
county in Indiana? Card i\'�. ` � Yes� No
Deduction approved in the amounf of:
20��
Signalure
COUNTY AUDITOK
zo � I zo P I zo I zo
County Audilor
zo
Dale
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We certify under the penalty of peryury that the above and foregoing infortnation is true and corted and that ihe applicants was ! were
�esidenl of Indiana and owner of the aforementioned property on March 1, 20
full
address of aOPlipnt
Person authorized by duiy executed Power oi Attomey
or by IC 6-1.1-12-.07
of authorized person