Mortgage_Bazer' � � � � (1M,p,�
^�� STATE GE OR CONTRACT INDEBTEDNESS Coun Township Year
= FOR DEDUCTION FROM ASSESSED VALUAT� ���
- �r_ . • State Fortn d3709 (R11 / 6-09) .
' y,� � Presaibetl by �epartmeM a( tn�al Gwemmenl Fi�fance
File Mark
.isTrrucnoNS:
To 6e filed in Y ry a nJ�2h6a��r � �°°,� �a "�",:
person a b mail wiN Ne Coun Auditor or Coun Recorder o/ the coun �s located.
Fil'mg Dates: 1) Real Pmperty Must !!e during the year for which the deduction is sought. � County Auditnr
2) Mobile / Manufactured Homes not assessed as Real Pruperty: Must file�diw�n (12) months
before March 31 0/ eacA year the deduUiar is sought County Reoorder
See reverse side for addiGOnal instrucfions aM qual�cafions. T R
noofuan� lawnerarcontraG hu�er- see restiirl,urts m re��asde)
A�sessed raNe d real piaperty
A1a�U 1. amrlrt year
If ro. wha� a his / her exatl sh
u narne on reoord's drtrerenc u
� �1 � Q
KeY�le9al�rX p /�
Mat d a7P�t udinre bebw.
IJam¢ W rtwrigagee m mntract seller
Address of morlga9ee w m� sel�
Name of assignee w oNU wm or h
AEGress of assvry�ee (numDar ar�C sb
Does eppficant wm pfoperty in any otM
counry in Indena? ❑ Yes
/
Dr�uctian approved'o� tl�e artnum oE
20 _ 20 _
����
� � o�
_IO�'�-0 l,� rxemmp�� P�o�ubo(�
vYJ �
rtederess unpaid as U Mangaqe / Conttati vNe6tetlness impaid as o7 Is Ne eppGmnt tlre sde
��..�� date of appGcaiion �eeai w epurtade vnmeY?
If owned wiN someone other ttan spouse, indimte with whom
_'-•^. � ZIP_ootle)
dAZ�r, �+,�z E
20
� / / � �
I I We cert'rfy under Ne penalry of perjury t1�4 Ne above and
owner / mntract buyer of �he aforementioned property on da
appfcant (number antl sbeet, riry,
auUrofrzeE M' Euty ezewred
�a. �
#Aftorney or by IC 6t.142-0J
street, cry, state, end LP mtlej
Counry
ig infortnation i:
ation is filed.
20 _
Yes LI No
� tl� P�oDenY � Guestion: MfwaDy Assessetl
❑ Real RoPerlY ❑ Armual�Y A�sscd
RAohOe Hortie IIC E1.
��a� e� �a���e m w�r
� ❑ ves ❑
20 _ � 20
Date (rrnnM.
and cortect arM that the applican[ is a resident of Indiana aM
(rmah, daY. y'�a�
(mmN: daY• Y'��