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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
SWte Form a3709 (RS / 4-03)
Presrnbed by Depanmem of Local Govemment Finance
INSTRUCTIONS: �
To be filed in person or by mail with the County Auditor o! the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 0l the year the deduction is� �e Afl�ct�5
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side fo� additiona! instructions and qualifrcations.
(ownei or
Assessed�value of reai property as of
March 1, wrrent year ,
I( no, what is his / her exact share �of interest?
Key number / legal description
a /9-a3 s
MoAgage / ContraU indebtedn
March 1, curre t year
� ��
If name on record is different than that of appiicant,
of
or contrad seller
Address of mortgagee or contract seller (number and street,
Name of assignee or other owner or holder of morigage
below:
Address ot assignee (numberand street, city, state, ZIP code)
�ja�, .��
Record number ��
%^ � T Page number � / � /
V
unpaid as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other than spouse, �indicate with whom.
state, ZIP
Does applicant own property in any other I If yes, what county? What Taxing Distrid?
wunty in Indiana?
COUNTY AUDITOR
Deduction
20
, e<
>.d in thv�
/ � ,.
���..
�O . �\� \. o� '
20 I 20
Is the property in question:
❑ Real Property D Mobile Hmie
Has this deduction been requested on
property for current yeaR� Yes❑ No
20
20
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Si� �t a�O. •��� CountyAuditor Date
Ga'�
, We �� . �� .,iatty of perjury that the above and foregoing information is true and corred and that the applicants was / were
-a reside and owner of the afoSementioned property on March t, 20
Person authorized by duly executed Power o( Attomey
or by IC 6-1.1-12-.07
authorized person