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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ! .;,Ti: . -township Year
aikli FOR DEDUCTION FROM ASSESSED VALUATION t
J state Form 93709(RU/6-09) 1 � V" I
•��,5^.'1A Prescribed lry DePaRmerd of Local GovPmment Fnarce `
File Ma ii.
INSTRUCTIONS: • toms ctOa •
To be filed in person or mail with the County Auditor or County Recorder of the county where the property c.t••VO
Pe by ty N ty P PedY k located.
Firing Dates: 1) Real Property:Must file during the year for which the deduction is sought ill GO Z County Auditor
2)Mobile/Manufactured Homes not assessed as Rea/Property.Must Me during the twelve(12)months5Or1 Court
before March 31 of each year the deduction is sought - (j\8 LLLJJJ County Recorder
See reverse side for additional instructions and qualificatsii000nns. (�//�� ,,
Taw �`' '_"'rn alto sir -�� -Jcv (Si- oa� 6 1y Pao number
9 l3
„�of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract cdebtedness unpaid as of Is the app6 nt the sole
axmat year Maras 1,anent year ,5 date of appGcotron legal or equitable owner?
3Q g7S6 ❑ Yes ❑ No
It no,what Is his/her exact than 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 pf rertgagee or contract seller
Address sof~,i/mortgagee or ct seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,tax state,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? for current year?
Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County Date(srad4 day,year)
I/We certify 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
owner I contract buyer of the aforementioned property on date application is filed. .
Signature(owme/s All name) — (month,day,year)
resdent pfr�t(rwrber and street.aft state,and ZIP code)
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Person authorized by duly executed Power ofAtttmey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code) .