Mortgage_Bye �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couhty Tow�i,sshipppp Year
. FOR DEDUCTION FROM ASSESSED VALUATION F �l 1�
I'� State Form G3709(R71/6-09)
Prescribed by Department of Laml Government Finance
File Mark
INSTRUCTIONS: D r _ TI
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.
2) Mobile/Manufactured Homes not assessed as Real Property.'Must file during the twelve(12)months I ej
before March 31 of each year the deduction is sought I '. �i,lTnry Recorder
See reverse side for additional instructions and qualifications. 01 BSO C- - • •
i
t owner or conbartb see on'eve side
ADro iS "` .°�
Taxing Disiii Key number/legal description Record number Page num
1,L tg.a....� ,� at. - l 3 - 14-A°a -ar_-4e - ham I t3 SCo I
d value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of is the appfi ant the sole
Mardi 1,anent year March 1,current yen 7� (4,-9 date of application legal equitable owner?
a IA D � 1 es 0 N
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 deferent than that of applicant,indicate below: Is the pioperty in question:Annually Assessed
heal Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellelr
3 Qa L
Address of mortgagee contract seller(number and street city,stale,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,slate,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? ..��-----��11x////����� for current year?
El Yes o I [ es ❑ No
—
COUNTY AUDITOR I — - —•Deduction approved in the amount of. / L.
20 20 20 20 20_ �y � , �.
-Signature of County Auditor ' County Li (4 '
I/We certify under the penalty of perjury that the above and foregoing information is true and correct /\� —
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owns name, __._tnunm,day,year)
FFuresident address of applicant(nun and street-thy,state,and ZIP code)
3 S . Pti . ca
erson authorized by dory executed Power of Atiomey or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city.state,and ZIP code) _