Mortgage_Porter aT. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f:- r
FOR DEDUCTION FROM ASSESSED VALUATION
t' State Form 03709(R71/609)
Prescribed by Department of Leval Government Finance
File Mark
INSTRUCTIONS: r
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is boated.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought •- I ( • .
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought. -
4. ••
See reverse side for add'- I instructions and qualifications.
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Appbtanl(owner orcon b -see restrictions an,ryrerse sid9�
IItO'y skit) /
Tor D 6 o f Riot-F�3. 01-11 oa8 GI ,p „C,eJNf Camber
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March f,arwpt 3r data of application legal or equitable owner?
l/Q ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ()l`t
Address of mortgagee or contract seller(number and street city.{lslate,and ZIP )
Name of assignee or other owner or holder of mortgage -
Address of assignee(number and street city,state,and ZIP code) goo Ie-f ? A
7 JMS.
Does applicant own property in arty other If yes,what a ' (p S 75o w n on been requested on properly
county county to Indiana? ❑ Yes ❑ No / ❑ yes ❑ No
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pj- q77/
Deduction approved in the amount of
20 20 20 20
I I
Signature of County Auditor - County Date(month,day,year)
I I We •-rtify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
own: I contract buyer of the afore ntioned property on date application is filed.
r :es full name) / J Date(month,day,year)
ut •tares apprynt(nu and sbee ,state,and 7JP code) 476 70
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street dty state,and ZIP code)