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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION T�iS . Year
�'..w� I StateFwma3709(RSl4-03) �
� I Prestsi6ed 6y DepartmeM of Lotal Govemment Finance
L � �
INSTRUCTlONS: File Maric
To be filed in person or by mail with the County Auditor of the county whe�e fhe propeRy is located. �-y,,
Filing Dates: iJ Real Property: During the 12 montbs before May 11 0! the year the deduction is to be eKect ve.� ��
2) Mobife Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the�G�"e @edUCiiXn�,}Jtil Tfe�effective.
See reverse side for additional instructions and qualifications.
�owner or contract nuyer - see
Assessed value of real property as of
March 1, wrrent year
reverse side) �
Key number / legai description Record number
��O-�l-o/-vo3-d0.3.797- �ao7
� j8 Page number
ol`�.- 037 9 ,�-a� l38
Mortgage / Contract indebfedness unpaid as of Is the applicani tJye sole legal or equitable
March 1, current year owneR �Yes ❑ No
�
i • I/
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
eal Properry ❑ Mobile Home pC 61.
�me of mortgagee or contract selier � ���
of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (num6er and st2et, city, state, ZIP code)
Does appiicant own property in any other I If yes, what counry?
county in Indiana?
�.��� x�
�LB,�b
�ac�n- ►3s
What Taxir � �+�� �� quested on
] Yes � Na
COUNTY AUDITOR
)eduction approved in the amount of:
20 �_ 20 �_ 20 0� 20 20
� �
iignature County Auditor
20
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
r
Person authorized by duly executed Power of Attomey
or by IC 6-1.7-12-.07
of aulhorized person