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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION T Coun 7ownship Year
���� J State Form a3709 (RS / 6-03) . y, �
P25cnbetl by Departmeni of Loral Guvemmem Finance p y
a.
INSTRUCTIONS: APR 2 5 ZOO6 ile Mark
To 6e filed in person or by mail wiih the Counry Auditor of fhe county where the property is located. �y
Filing Dates 7) Real Property: During the 12 months before May 11 of the year the deduciion is to�b"e;eN�cEd/ .e`�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March GIBSONy��UT7�(`���t�F� to be ef(ective.
See reverse side for additional instructions and quali�cations.
Taxing
(ownerorcontract buyer- see restrictions on reverse side)
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interesl?
/ legal description
V 1 '1 ^ (�
MoRgage / Contract ir
March 1, wrrent year
If name on record is different ihan lhat of appliwnt, indicate below:
of mortgagee or contrad seller
Rewrd number
�
- � Page number
l ot.
s unpaid as of is the applican t�sole legal or equitable
owner? es ❑ No
If owned with someone olher than spouse, indicate with whom.
Is the property
❑ Mobile Home pC 61.1
Address of mortgagee or co ad ler (number and street, city, state, Zlf ��µ B u p J 1 �N 1 ��
U " ,� ��
Name of assignee or other owner or holder of mortgage �" —
Address of assignee (numberand sfreet, city, state, ZIP code) O(„ � I O� �
V1
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current yeaR� Yes� No
Deduction approved in the amount of:
20 �/ 'L, 20 ��_ 20 ��
� P
Signature
COUNTY AUDITOR
20
County Auditor
20
�:
Date
3�]
We certiy under the penalty of perjury thal lhe above and foregoing information is lrue and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�nature (owners /ull name) � Person authorized by duty executed Power oi Atlomey
i�(11 A 0_ 1.i -� ..._ �.. or by IC 6-1.1-12-.07
resid�e1nt address of applicant C1 Address of authorized person
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