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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stace Fortn a3709 (RS / 4-03)
PresaiCeA by Department a1 Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is /ocated.
Filing Dates: 1) Real Property: Dunng the 12 mon[bs belore May 11 af the year the deduction is to be effective� E � 4 2QQ3
2) Mobi/e Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 0/ the yearlhe deduction is to be eHective.
See reverse side for additional instructions and quafifications. � '� `� ��
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G1BSOtJ CO! �_ - . _ ,.. .
or contract
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resMctionsQyn /reverse side) 1/ q�.
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number / legal descriplion
-Q� ya q IPage
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Assessed value of real property as of Mortgage / Contract indebtedness ufipaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on
mortgagee or contract
of applicant, indirate below:
Address of mortgagee or contrecl seller (��nber and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county7 What Taxing District?
counry in Indiana?
Deduction approved in the amount of:
20 �r� � 20 �� � 20
COUNTY AUDITOR
��i��
P I P
County Auditor
s the property
❑ Real Property ❑ Mobile Home (IC 61.1-7)
Has this deduction been requesied on
property for current year? � Yes ❑ No
20 �� 20
P
We certify under the penalty of perjury that the above and foregoing information is true and corcect and that the applicants was / were
��sident of Indiana and owner of the aforementioned property on March 1, 20
(owners full
Person authorized b�
or by IC 6-t.t-12-.07
IAddress of authorized person
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