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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�+ w� ♦ State Fortn a3709 (R5 / 4-03)
� PrascnEtN Dy Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with fhe County Auditor of the county whe2 the property is located. ��� O 3 200!
Filing Dates: 1J Real Property: During the 12 months 6elore May 11 of the year the deduction is fo be ef/e T
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ tAe year the deduction is to be eflective.
See reverse side for additional instructions and qualifications. ��'�t /%
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Applicant (owne�or n ct buyer- see re fn �ons on ieverse ide
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Taxing Distrid Key number / legai description Record nu ber �
P�: O/ � _ /rj \ /� �D ^_ , Page number
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Assessed value of real properiy as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the soie legal or equitable
March 1, curtent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned wifh someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hort�e (IC 51.1-�
me of moRgagee or contrad seller
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Address of mortgagee or contract seller (number and street, city, s te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaf?� YesO No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 U 20 �J� 20 20 Q� 20 Q� 20 20
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Signature County Auditor Date
�� We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on MarcFi 7, 20
Si ( ers (ull name Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resid t address of applicant Address of authorized person
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