Mortgage_Fetcher'"n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun sni vear
;.---
• FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm G3709 (R71 / 6-W)
,«. r Presaibed M DePartmerd o1 Lmal Govemmenl Fu�amc
� File Mark
lSTRUCTIONS:
o be filed in rson w b mail with fhe Coun Auditor or Coun Recorder of Ne coun where the ��� ��
ae r h a ry woaem;s��ea.
F7'mg Dates: 1 J Real Praperty Must fde dunig the year (or which fha deduction is sought. � q�d��
2) Mobr7e / Manufactured Homes rwt assessed as Real Pioperty Must file durirg the hveNe (12) months
befwe March 37 of each year the deduUion is sought ❑ � �
See mverse side tor additional instructions and quali�cafions.
GIBS
MP�m (awrer or contrae 6uy�- see reunuions m reverse si0e)
/(/ /
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Taarg Distr"vY Key nimbet / legal de.saiption Reto�d number Page nwnber
a� - ��- b� - 3 0 3.0o v.9 � v-o �
�ASSessetl real pmpaty d A�b2qage �'traG/ � n� unpsid as d Moetgage I Canuac2 rtWebeedness �mPaiO az of Is Ihe aPPrman� O
Ma�rh 1. armnt year mh _ - — . — — . • .
J �
li ro, whal'a his l her exxl
tt narne m �emrtl a Sfierent Nan thal W aDP�N• mtlirate belvr.
Name of rtiortgagee or mnbact selle /l/ /J (%'� �
! 7 C Lilt% .,
Address o( mort9agee «mnbad seAer (num6er end stree4 �Y, ' e, and ZIP code)
Adtlressofassign (number ntlstree4
�
Does applinnt ovm prope,rty in any oNer
munty in InOiana?
❑ Yes
D�ucoon appioveE N tlre amount ot
zo
Sig�ahne of Coimry Auditar
I If yes. whal muntyt I
No
�
COUNTY,
�_ , zo , �o_
I 1 We cert'rfy under ihe penalty of perjury that the above arW foregoing infom
owner / mntract buyer of Ne atorementioned property on date application is
,o�
tiry, state, aM LP code)
Pddress of aW�or'ved person (numbera.M sneet uN. s+ate, anC LP aode)
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f'� '�SE�
���C�� eQC61.
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P�W�rtY
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