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.+"�'�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
;i 3 FOR DEDUCTION FROM ASSESSED VALUATION °-
Sfate Fortn a3709 (R71 / 6-09)
�� ,.,. l Rescnbtd by Departmenl W Lor,al Govemment Finance
eM
INSTRUCTIONS:
To be l/ed in person or by mail. �F r��ea n:
Filing Dates: 7J Real Property: Must be completed and dafed in the calendar yearlor which the deduclion is sou . ��`
Must be filed wi(h the CountyAvdifor or County Recorder o/the county where the pmperty is located � ,County Auditor
on o� before January 5 olthe immediafety succeeding ca/endar year. N�V ����ry Recorder _
2) Mo6ile / Manufacfured Hanes nof assessed as Real Property: Must file wilh the Counry Auditor o7 (he -
county whare the property is locafed during fhe nvelve (72) monfhs be/ore Maich 31 0l each year the ,,,vvv���---��rr--��---
� deduc(ion is soughl. C���•, ^�-�
See reverse side lor addifional inatructions and oualificafions. �l C� l� �
Key
�d value U real p(operty as ol
1. ament year
II no, wha� is Ns / her ezact share
on
Name ol azsgnee or ottier owner w twWer of mortgage
ACdress ot assignee (number anC streef, dry, sate, and
�erse side)
�� �. �
Eescnp
3-��._.-'
artentyear
Cnl:
Es. W1� ���;
.00� �gs-oa
s uopaid as o( MoRgage / Cc
someone
r' Recartl number Paga number
Instr�ne
IebteEness unpaid as of Is ihe app van e e
legal w �equ!itade owner?
��� L7Yes ❑ No
n spouu. "uMirate wiN whom
Is iha p perty in ques�ion: MnuaDy Pssessed
eal PropeM ❑ MnualyAssessed
Mobile Hwne UC 61.1-1
I Does appGcant avn property in any oNer I If yes. what counry? I Whai Taring �isViG? I Has this deduction Deen requesteG on Property I
county in InEana? for current yeaR
❑ Yes ❑ No ❑ Yes ❑ No