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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`' ' FOR DEDUCTION FROM ASSESSED VALUATION
��w� J State Fortn a3709 (RS I 4-03)
PreSCriDed by Department of Lotal Gpvemment Finance
INSTRUCTIONS: �
To be filed in person or by mail with the County Auditor ot the county where the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months before May 17 0/ the year the deduction i�� eBe�t�Z� fl]
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the year the deduction is to be eHective.
See reverse side for addifional instructions and qualifications. ��
Applicant
or contract
reverse
�/'!6� �
JN COUNTY FUDITOR
Taxing Distrid U Key number / legal description Record number /�
�/�, �y� zc�-t�.-o7-�03-00(.5/6-oa8 0 (
� L�D`�(p�W OI�I – bl•Sl�_pp Pagenumber � /
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year � owneR ❑ Yes ❑ No
— � c -- (� �7
If no, what is his / her exaa share of interest? a �/lJ �— an spouse, indicale with whom.
If name on
than that of
of mortgagee or wntrad seller
�
��Y� ��. �
Address of moRgagee or contrect seller (number anc
of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
20�_
Signature
20
.. --_ , ur
�' " P�°PertY
��� zl Proper
G
�
What Taxing District?
COUNTY AUDITOR
20 � 20 20
P
County Auditor
y ❑ Mobile Home (IC 61.1-�
�
Has this deducfion been requested on
properfy for current year?� YesO No
20
Date
20
(fy under the penafty of perjury that the above and foregoing information is true and corred and that the applicants was / were
of Indiana and owner of the a�ementioned property on March t, 20
Person authorized by duly executed Power of
or by IC 6-1.1-12-.07
applicant n ` IAddress of authorized person