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"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Vea
__ FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fwm C3709 (R71 / 6-09) �
. �' y,. Presmbed by �epartrtrent of Local Govemment F�nce
� de
�NSTRUCTIONS:
To be filed in person a by mail with the CounryAUditor or Counry Recort/er, o! fhe counry where the property is locat F
Fd'mg Dates: 1) Real Property MustlJe dumg the yearfor which fhe deduction is soughL Coun Audimr
2) Mo6de /Manuladu�ed Homes �t assessed as Real Property: Must file dunng the hvelve (12) months �f�1' ty
befora March 31 0/ each year the deduction rs sought. ! � T [A7tlWty Recorder
See Ieverse side foraddrfiunal insWcUons and qua/fications. I C. J.
AGP��� ( ��a buye�- see rpsfrFtions m{Pyerse vde) ..., n 1 . /'1 ' _ \\ �
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MATJf i. P
It �wne m recad'a QtRerent than Iha� o/ aPpGrant,
Name a �qrtgasee «concaa seuer
Addres of �ragagee w mntrad se0er (mmbri ar
Name of assignee or othnl wmer w holder of mork
AEtlress ot auignce (num0er aM svee4 �N: s+a1e,
Daes eppGmnt own property in any ot�er
munry in IMaria?
❑ Yes ❑ No
20 I 20
crty sta�.
If yes, what munty7
Fi9
a� y3S oa� �� P� -��
1 as W Mortgage / Contrarl udebcetlness unpaid as d Is Ihe appG�t Ne sok
` date of appfmalion legal or equita6le ovm�t
� ❑ Yes ❑ No
N owne0 with someo� other Nan spouse. iMifate wXh whom
Is tM G�P�Y in question: Mnua�Yl�sse55eE
❑ Real Roperry ❑ Nmually Assessed
Moble Hwne (IC 61.1-�
AUDROR
been 29ueste0 m P�rtY
20 _ � 20 _ � Z(1
�raLae W Gambnwiwr I I CaunN I Date (mon+11, tlaY.Y��
I/ We certify urWer Ne penalty of perjury Nat Ne above arW foreguing intortnation is We and cortec[ and that the applicant is a res&lent of Indiana arM
owner I contract buyer of the aforemerrtioned pmperty an date application is filed.
f ��A 7 Y 1 0 � Date (monfi, daY. YBa�)
P$son aWro�aed by Eidy ezewted Powri af Attorney or by IC 61.1-12-0.7 I Dat¢ (mpn(h, day, yea�
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Mtlmss d auCwrtrcd pmsm (num0erenE saee4 �ifY, sbfe. and LP mde) .