Mortgage_Kinder"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou o Year
_.. � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 03709 (R71 / 6-09)
�' ,,,, f Presaibad by Departrtierd of Lmal Govemment Ffance
F' a
INSTRUCTIONS: C
To be filed in person w by mail with the CountyAudi[or or Counry Rern(de� oI the county where fAe property is located.
Fifing Dates: 1) Real Property: Musf !fe during fhe }rear lor which the deduction is soughf. Auditor
2) Mobde / Manufactured Homes rat assessed as Real Proper(y Must fiie dunng the tweNe (12J moqA$SON COIUIgTy������
betae Maich 37 of each year fhe deducfion is sought L
See reversa side 7or adtlitional insfnictions arM qual�cations.
nwnber
frealp�pertyazd ' A1ort7a9e/COniraa"uWebtedness
ypar Mamh 7. artent year
tl rume m n.mtl'a C'iflerent Nan thaf W appBCant. cidirate Gelm.r.
Name o1 mMUaflee n oontraM seller
���
owner
��.
AACress ot assignee (�n+m0er aM slree4 �: s+ete, and LP ootla)
Ooes aPpManl ovm property in any oNer If yes. �Mal couny?
counry in Ind'gna? M�
❑ Yes 6{i�T�lo
20 � 20 � 29
20
Recofd nurnbv
�= � � �
az of Martgage I Crn'.�aU hitle6teCness unpaiE as of I
dale of appGtalion I
sameone other tt�an spaise.
NTat TOring Disfri�
Counry
20
owneR
n No
I�Pr°°e`"ir � �( •�
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, � D�R-� �R-,� a
t�� p
o�
� ��� � �=
�
Date (rtanlh. tlaY• Y�+)
an piopcly
20
I I We certify uMer Ne penalry of perjury that the above and foregoing infwmalion is We and cortec[ a� that Ne appli�ant is a residertl of Indiana and
owner I mntracl buyer of the afwementioned property on date applicalion is filed.
�tature (o�vr�YS MI rame) / .-. Date (rtronN. daY. Yaa�)
riry, slate, antl
autha¢ed Dy dWy ezea�4d Pbwer of Attomey
IC 67.1-12-0]
person (numEeraM Sbee; My, sfate,
tlay,
v