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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION � ou nship Year
•• �� � ! Su:e Fom; a3709 (R5/ a-03)
PresaiOed by Departmem ol loral Govemmem Finance
I �
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is locat�,�'/j ,Q�
Filing Dates: 1 J Real PropeRy: During the 12 months before May 11 0l the year the deduction is t6 6e�''5 qUDIT�R
2) Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March ����y�iYA�4�eduction is to be el%ctive.
See reverse side /o� additional instructions and qualifications.
(owner or contract
Taxing Distrid
0
see restnctions
Assessed value of reai property as of
March t, current year
If no, what is his / her exact share of interest?
Key number! legal description Record number
o CY�S
Page number
O�Q-oal �-� as3�
Mortgage / ContreG indebtedness unpaid as of Is the applican the sole tegal or equitable
March current year owner? es ❑ No
7 J�'yQ-�
If owned with someone other than spouse, indicate with whom.
I( name on record is diHerent than that of applicant, indicate below:
mortgagee or contract seller
�-
Address of mortgagee or contrad selier (number and sfreet, city, sfate, 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
county in Indiana?
� T JL 1 "oC� IV
Deduction approved in the amount
20 u�
P
Signature
property in question:
al Property ❑ Mobile Home (IC 61.1-�
Drawer NO..���.......
If jres, what county? What a g� q uested on
Card NO . ..................... I Yes� No
� 5�t, ooa
I (o � COUNTY AUDITOR
20 � I 20 PJ "1 I 20 20
�� �
� Couniy Auditor
20
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and that lhe applicants was / were
resident o( Indiana and owner of the aforementioned property on March 1, 20
Signa re wners (ull narr�T�) n Person authorized by duly executed Power of Attorney
� f 1 n� �% � I\�l n,., �n. II or by IC 6-7.1-72-.07
Full resident address of applicant Address of auihorized person
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