HomeMy WebLinkAboutMortgage_Hartley (2)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�+ / State Form 437W (RS / 4-03) .
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P Ded b D
� resrn y epartment of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail wifh the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before May 110/ the year the deduction is to b�lft?ctiZe9 20�4
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 of the year the deduction is to be ef(ective.
See reverse side for additional instructions and qualifications. � y/ - -
i,
GIBSOC C�i, _ .. -- -
or
Taxing Distrid
Key
reverse side)
legal description
n
numbe� �y f /� � �
J
number
"'�'.v'�""' V � V / Q
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is lhe applicant the le legal or equitable
March t, current year March 1, current year owner? �❑ No
a 3.�s v.'
If no, what is his / her exact share
If name on record is different than that of applicant,
mortgagee or contract seller
" If owned with someone other than spouse, indicate wit� Oo�n
aG - av -v� -�o� 6GO. /38-�
below: Is lhe or ertv in auestiore
of mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(numberand street, city, state, ZIP
Does applipnt own property in any other I If yes, what county? Wha�
county in Indiana?
Deduction approved in the amounl of:
20
Signature
20
COUNTY AUDITOR
20 Q� 20 � 20
� P
County Auditor
❑ �al Property ❑ Mobile Hmie (IC 61.1-�
y
Drawer NO. C? ��.- o —
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Card�NO. „
...........
auested on
� Yes � No
20
Date
20
I/ We ceAify under the penalty of perjury lhat the above and foregoing infortnation is lrue and correct and that lhe applicants was / were
♦esident of Indiana and owner of lhe aforemenlioned property on March 1, 20
(owners full name)
. ,� � i
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident address of applicanl �Address of authorized person