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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION � Year
S N�� � Siate Fwm a3709 (RS I4-03)
� Prcscribed by Department of Local Govemment Finance �
INSTRUCTIONS: ��/' 6 e Mark
To be filed in person or 6y mail with the County Auditor of the county where the properry is loc�ed.
Filing Dafes: 1 J Real Property: Dunng the 12 months before May 11 of the year the deduction t�� ��e�E��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year t s'de�iictftiJ���be effective.
See reverse side for additional instructions and quali�cations.
buyer
Taxing
Assessed'va7ue of real property as of
March 1, current year
no, what is his / her exaci share of interest?
Key number / legal description � Record number
v
D�9-: �OS38-ocs "°number D
MoRgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year '�� � � � �, owneR ❑ Yes ❑ No
3300-� '
If owned with someone other lhan spouse, indicate with whom.
If name on record is differen[ than thal of applicant, indicate below:
mortgagee or wntreIX seller
- - .� i_�
Address of mortgagee or contrad � � - - - � —
Name of assignee or other owner � K��/J �� !� � l.� �� �-�
SCN rn rrS _
Address of assignee (number ana
J� - /b�o
Does applicant own property in any o[nei I ii yc,, ..,,a, ,,,,,...,, I �}?
county in Indiana?
Deduction approved in
20� 20
P
Signature
�e amount of:
f� 20
� /
COUNTY AUDITOR
20 i`
County Auditor
� �.
.
is the property in question:
❑ Real Property ❑ Mobile Home
Has this dedudion been requested on
property for current year? � Yes � No
20 � I 2�
We certify under the penalty of peryury that the above and foregoing information is true and corred and lhat the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
(owne�s
resident address of applicant
0`] �.
Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
person