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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
• FOR DEDUCTION FROM ASSESSED VALUATION
/ Slate Fwm a3709 (R5/ a-03)
PrescriDeO by Depariment of locai Govemment Finance
INSTRUCTIONS:
Coun Township Year
File Mark
To 6e filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 110/ the year the deduction is to be e/%ctiv�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2�e7'r� � t�d ctio is t be e((ective.
See reverse side tor addifional inshuctions and qualifications.
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Applicant wner or c ntract buyer trictions on reverse side)
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Taxing isVict Key number / legal description cord numtierJ i"" 7pR �
/� ��� ��9-0 �o i� _o � �,BSON �����F�
Page number � �
Assessed vatue of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share oT interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-7)
e of mortgagee or contrec�t je�lle�r � � �,.� `
// (/��L 'UIC ���/�Q.�.c� ,�ici..t.erx.
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requesied on
county in Indiana? praperty for curcent year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo y�_ 20 �s zo zo � zo � zo 4 zo
, P � P
Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was I were
�esident of Indiana and owner oT the aforementioned property on March 1, 20
Signatur wner' name �- Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
i
ul 'esi ent address of applicant Address of authorized person
03 �
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