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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Stzte Fortn a3709 (RS / 4-03)
Prescribe0 by Departmem of Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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File Mark
To 6e filed in person or 6y mail with fhe County Auditor of the county where the property is locate�.' � �, � O
Filing Dates: 1) Real Property: Dunng the 12 montbs before May 11 of the year the deduction is toLbe efleNctive. ._,_ �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o�f6e�year-�the deduction is�fo"tie effective.
See reverse side for additional instructions and qualifications.
Applicant (o er cont2ct 6uyer- tncti s rever ')
Ta�cing Di Key nu r/ legal desuiption Record number ��
D/n 0a��/�, —oO Page number �0��
7 �' �T �i
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, curtent year March 1, current year ownef? ❑ Yes ❑ No
aaae�o .
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 lhan that of applicant, indicate below: Is the property in quastion:
❑ Real Property ❑ Mobile Home QC 61.1-�
�-ne of mortgagee or contraU seller
Address of mortgagee or contracl seller (number and street, city, stat , ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
� Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year? � Yes❑ No
COUNTY AUDITOR
Deduclion approved in the amount ot:
20 � 20 � 20�_ 20 Q� 20 20 20
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Signature County Auditor Date
� We certify under the penalty of perjury lhat the above and foregoing intormation is lrue and corred and that the applicants was / were
asident of Indiana and owner of the aforementioned property on March 1, 20
Signalur (o ners Iull name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
F II reside ddress of applicant Address ot authorized person
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