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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS :y w.. t I Year
r % FOR DEDUCTION FROM ASSESSED VALUATION h W
Tic / State Form '3709(R 11/509) 1
\f,..,5,,,±.}:'. Prescribed by Department of local Government Finance I DEC 2 6 FZUBark
INSTRUCTIONS-
To be filed in person or by mail. I Form fife ray
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is song County Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is boa' I
on or before January 5 of the immediately succeeding calendar year. GIBSON COUI BE
TOUTQTecorder
2) Mobile/Manufactured Homes not assessed as Real Property:(dust file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. I
See reverse side for additional instructions and qualifications.
!Appl1^ � M
icant(owner or contract buyer-see restrictions on reverse side) I
I Z1i-05-57-117,000.3S'Dl7 Lo-/- / )enuerJones&rm //O/7orr UL&
�Taring District ey number;legal desUi0.ipn I R=- npn' ° e hunt
)hr.�- I Ma -ma f eitirK4-[a.icret K. Nair I: ; I , 6 3 .I�ti37
I Assessed valu real properly as of I Mortgage!Contract indebtedness unpaid as of Mongage!Contract indebtedness unpaid as of Is the applicant the sole h
Mardi 1.current year i March t,current year Ott of application legal or ecuitaye owner?
,m�}pp7
/ 0,7; � , Yes ❑ No I
i If no,what is his!he,exact share of interest? If owned wtth someone other than spouse.indicate with whom I
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IIf name on record is different than that of applicant,indicate below Is tie property in question:Annually Assessed I
Real Property ❑Annually Assessed 1
Mobile Home(IC 6-1.1-7) ;
IN-ntmo.ya_eeor contract seier 3—.30-405 //„no/ ,u S I
-fii�/1 `Kt CICZVK ).John ,/l y p..Jo
IAddress of mortgagee or contract seller(nun(ber and street,city.state,and ZIP code) I I
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Name of assignee or other owner or holder of mo:gage I I
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I Address of assignee(number and street,city.state,and ZIP code) I I
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested on properly
county in Indiana? ❑ yes No Ifor current year? ❑ ❑
Yes No I
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1 COUNTY AUDITOR I
I Deduction approved in the amount of
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20 20 I 20 I 20 20 I 20 20
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Signature of County Auditor County . I I Date(month,day.year) I
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II(We certify under the penally of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
1 owner/contract buyer of the aforementioned property on date application is filed. I i
I Signature(owner's n.yrame) Date Imonth,day.year 11 1
Full r s en a dress of applicant e tuber and st_ t.city,slate,an ZIP code) 1 h
I E. \/Doti /� Rd / I-IPZEGTWJ, /� 4/1/010 I
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IPerson autnodzed by duly executed Power of Attorney or by IC 9-1.1-12-0.7 I I Date(month.day.yea.)
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I Address of authorized perse' (nu.roer and street.city,state.and ZIP code) I j