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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION C To i Year
^. M� / Stare Fortn a3709 (RS I 4-03) • '
� Pfesaibtd by Department ol Local Govemmem Finance J N�j 3 ZOO6
INSTRUCTIONS: �,
To be filed in person or by mail with the CountyAuditor of the county where th�e property is located. �'C� TY AUDITOR
Filing Dates: 1) Real PropeRy: During fhe 12 months before May 11 0l the year the deduction is to 6e 6il�ot/a�.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is to 6e ef/ective.
See reverse side !or additional instructions and qualifications.
(
Key number / legal description
G/g -ao/�s-o�
Mortgage / Contract indebtedness i
March 1, current year
'� �. /G 5. �
Record number D�
Page number
7�aa
as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
I( no, what is his / her exac[ share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
� ❑ Real Rc�perty ❑ Mobile Hmie (IC 61.1
�me of mortgagee or contra seller
�'��eo�h �ar d
Address ot mortgagee or conlract seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and s12et, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
What Taxing District?
COUNTY AUDITOR
Deduction approved in the amount of:
zo 01 Dra�ti�er i1'Op2,�Q j-%��� 20
P ........ -
Signature. Ca1'd NQ, litor
.....................
Has this deduction been requested on
property for wrrent year? � Yes � No
zo
Date
�
We certify under the penalty of pery'ury that Ihe above ana ioregoing information is true and correct and lhal lhe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
iull
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.a c�r �
Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person