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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Fortn d3709 (R71 / 6-09)
�' ,,,, f Presoi6ed by Department of Laal Govemment Ffarce
File Ma
INSTRUCTIONS: SEP
To 6e filed in person or by maii with the CountyAUditor orCounry Recorder of Ne counry where fhe pioperry is IocateQ. ��
Fi7rrg Dates: 1) Real Property Must file durirg the year fir which the deducfion is soughG `��� Counry Audimr
2J Mob�e /Manufactured Homes rwt assessed as Real Property: Must ne during the fweNe (12) months
behra March 37 of each year the deduction is sought G�BS �County Recorder
ON Cn� �. _ �
See 2verse side Ior addit"qnal instrucUons arrd qualifications.
AppGCant (owner qGam�tra�uye�- see reslm,L"ons on rererse siCe).
I�!"S7TRST7
tt ro. what Ls h'a / Mr e�] sham af infeJesi?
artent yrar
tt name m �ecpd's CAlemn[ Nan �hai ot aPpGran4 ��� belovr.
Name oi nxwtgapee
sbce4 �Y. state.
oUcer owner or holder of morcgage
AaCress of assi9nee (numberaM stree4 �Y, sfafe, and Z/P cotle)
3`fzG oa
mmewie
� Recortl number Page numbnl
a�1 a- �I '191�
bteOness unPaid as d Is Ne aGG��t tlie sde
legal w eqWta6le ow+wR
❑ Yes ❑ No
spouse. uWkate �NN wtpm
Is tlre pmperty in Question: Mnually Assesud
❑ rxea� Propem ❑ a,nua�y A�sea
Mobile Fbme IIC 61.1-i
Does aPWitanl own properry in any oNer If yes. what counryt Whal Tadng D'¢trict7 Has IhiS dedudion Deen repuested m proputy I
munty in Ind�ana? ❑ No fw curtem yeaR � Yes ❑ No
❑ Yes