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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�> ! State Form a3709 (RS I 4-03)
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� PrescA�ed �y Department of Loral Govemment Finance
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INSTRUCTIONS: �}—� � ! File Ma� �
To be filed in person or by mail with the County Auditor of the county where the property is located. � ' �� �
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be eRective
2J Mobile Homes assessed under IC 6-L 1-7: Between January 15 and March 2 0/ the year th�6eductio"n �4be eNective.
See reverse side for additional instructions and quali�cations.
(ownerorcontract buyer-see
Taxing Distrid
Assessed value of real property as of
March 1, wrrenl year
If no, what is his / her exact share ot interest?
nons on reverse siae}
Key numb / legal d
� -- t�c
Mortgage / Contrect i�
March 1, current year
If name on record is different than that of applicanl, indicate below:
mortgagee or wntrect seller
Record number
Page number
- ao sa19
s unpaid as of Is the appliqnt the sole legal or equitable
ownef? [�'es ❑ No
�
If owned with someone other lhan spouse, indicate with whom.
Address of mortga�ee or contract seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (numbe�and street, city, state, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amounl of:
20
Signature
r� e �
If yes, what county?
Is the property in question:
� Mobile Home (IC 61.1
What Taxing Distrid? I Has this deduction.h>�- "
, ��D :� . �a �l
couNrv auoiT Dra�� er �'�'
20 ��, 20 0 `1 �
� �
County Auditor
Card��• ..
Dale
20
�uestea on
� Yes ❑ No
We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and lhal the applicants was / were
(esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of aulhorized person