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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_, FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fam C3709 (R77 / 6-09)
`,,,, Preuribed �y �ePa�M of Lotal GovemmerC Flriance
File Mark
INSTRUCTiONS: a�
To be filed in person w by mail with the Counry Auditor or Counry Recorder o/ Ne counry where the property is locat .�j ���
FiNrg Dates: 1) Real Pmperty: Must 61e durirg Ne year for which the deduclion is sought. tl� � ry d'
2) Mobile / Manufactuied Homes rat assessed as Real Property Must file dunng the tweNe (72) moAMS
6e(ore March 37 of each year Ne deducfion is sought. �
See ieverse side foraddifionel insWCtlons and qualfications.
. o�ror�r-see on/O�s�da) � .
../I n ► ,n , n F „�/1. %�,n.,na , aA.ls-L
Assessed vahc cf rea1 P�Y %s
MBICh 1. aIIPl1i yY2f
�?= 0/- Gi'Jd. 'l- 0 � ��
' hbrtpage I Contraci irdehtetlnPSS unpaid as ot Morigage I Contract 6de6ted�s
Mardi 1. wrrem yrar dare af appaation ^^�
��` /
tt owned wPJi wmeone otl�er Can sPouse. t
If nama m remd'e UiRerent Man Nat of appOtant,'v�tlicate Oelrnr.
Nartre at rtnrtBaBee or mntrsu seller '
��
qAdtesy W martgagce or mntract sWer (nuriber erd svee4 �Y. s
Name o1 asv,{nee v Whc awner or halder af n�criga9a __
AECress af avs�nee (num0er entl straeG �1: smte. and LP code) r \\� cr N O•.�� � D. .......
Dra
������a�Y�,g ��,�.����� ��T��� ao�l3... ....
m,nry �n indana� ❑ ves ❑ No ..... ...
CaCCI \0• • �
COUNTVAUDROR �,�-� .�a�,a��'"
Dr�uman ePWO'+ed in ihe amount of: Qj(LQ}�46/1
.�/�
Zp _ 2p _ 2Q _ 20 _ 20 _ 20 _ 2(1 _
Sig�wre d Camry AW itcr Caunry Date (rtnnth. daY• N��
, I I We certify wWer tt�e penalry of perjury that the aDOVe and foregoing infortnation is true and cortect ar�d that Ne applinnt is a resident of Indiana aM
owner I mntract buyer of Ne aforementioned property wi date apdiptlon is filed.
� 1 � � Date (rtm�h, daY• Y�e�)
r ��
, I Fu�msden� W aPP��t (wmDer arW 4�l: stam. and Z!P aotle)
�' ;b ��ncr+�� 7G7a
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Pcson aWnr�d M duN exewted Power of AlmmeY w Cy IC F1.1-12-0.7 _ Date (rtimM. Ea1: l�� ' _ _
AdOress of eutlror'¢ed Dersm (numbe�eM sneet �Y. sfate. and LP mde) .
mvaid as d" � a equitade oxne!'.
❑ Yes ❑ No
drcate with whmn
]erty in Questiav Mn�a➢Y Asussed
ProPertY ❑ M!uiallYAss�ed . . .