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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Yea
�_. FOR DEDUCTION FROM ASSESSED VALUATION �
• Stata Fomi C3709 (R11 / 6-09)
�' ,.,. � Presaibed by Departmerk o( Loral Govemmerk Fl(mnce
ile
INSTRUCTIONS:
Fortn AeA wiN:
To be filed in person or by maii with the CounryAuditor os Counry Recorder o/ the county wfiere the pioperty is located.
Fi7hg Dates: 7) Real Property: Must file durirg tha year for which Ne deduclion is soughG N�5 ��� q�ditor
2J Mob�7e /Manulactumd Homes not assessed as Real Properly Musf file during fhe fwehre (12) rtanths O
before March 31 of each year Ne deduction is sayht Counry Remrder
See /everse side for eddifional instructbns arM qualificatrons.
�x�°N1'•`�Op1�r1bi�;���d��� �/ �� , /� ,1� �GIHSON COUNTY AUDITOR
�CJ sc�¢�t� u �7S
r � popeny as a
S�
n ro, wna� �s na i rrer eua
If name an remtd'a Eillera
,_
—�e���v
Me 1, artrerrt yeer
Name of rtnrtgagee a mntrarl se0er��/V V/
�
Add__ _'__'_—_ _ _ ... _. __. _.. _'_ _'. . _ . . .. ' '
Nan (
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A4d �'
/1
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— V 1
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�9� � �l
I $
c
I• -'^•�f1P:Sr,•%'SI
(number antl stree4
unpaitl
—Oo7.� ��Oec
ontracl uWebtedness unPaid as ot
someane
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f �
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eM LP
Geison (number arnd sbeet �l: stute, aM ZfP cade)
or eWttaq
❑ Yes
�
No
R propeny in CursGOn: MnuaM Assessed
Real PfOPenY ❑ ���Y�
� Moble Fbrt�e OC 61.
ias tha deductim Ecen reVUested m P�Y
or aurmt yea(' ❑ Yes ❑ 1
�— � �—
IDate (�. tlaY l��
d the applipnt is a resident of Indiana a�
U
Date (monM. daY• Y�