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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
FOR DEDUCTION FROM ASSESSED VALUATION .1
1!t, State Form 03709(R11/6-09)
Prescribed by Department of Loral Government Finance
File Mark
INSTRUCTIONS:
F P,!• 1
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought Court ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months 2
before March 31 of each year the deduction is sought - 1�I�. d°iJ i •• •ex
See reve .side for additional instructions 'qualifications.
� Oils GIBS= • . . . a:
Apr, r., o�//// - it • - lI- 'N'soi,.. r�i • S
Record n Page number
rtst.. idX m., 00-00- CIS? Dot 1 3 3K
!n.,>.vatic of real as of Mort¢age/ .. ...indebtedness unpaid as of Mortgage/Contrary indebtedness unpaid as of Is the app&wit the sale
1,qmN p.LA{/. n Mardi 1, nit J year date of appGra[gp legal or I Yes o N
C//)y4/ily///1 ❑ Yes ❑ No
If no,what Is he/her exact sham of interest? If owned with someone other than sp use Indicate with whom
It name on record is different than that of appficanL Indicate below Is property in question:Annually Assessed
Reel Property ❑Annually Assessed
�// )J J� I Mobile Home(IC 6-1.1-7)
Name at mortgagee a contract ender '1
Address of mortgagee or contract seller(number a t,city,state,and ZIP code) 44,..,Name of assignee or other owner or holder of mortgage e `Address of assignee(number and street,hey,state,and LP code) '
9T L - 7li
Does applicant own properly in any other If yes,what county? • What Taxing D'strict? Has this dedu ' been requested on property
county in Indiana? for current year?
❑ Yes
❑ No I ❑ Yes ❑ No
I
COUNTY AUDITOR
Deduction approved in the amount of:
141-661P.50 Oi iii '7J G
20 20 20 20 ?0
RI/CAC-It L.
Signature of County Auditor Ca
13 -51.35
I/We certify under the penalty of perjury that the above and foregoing informatic ndiana and
owner I contract buyer of the aforementioned property on date application is filet
3vz( �/ I .
Fullresiden applicant
(number and street,ory,slate,and ZIP code)
X ieZy5 5 /3rcc$c 0r 14.45+4df, rN H7631
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-03 Date(month,day,year)
Address of authorised person (number and street,crx state,and ZIP code) .