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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 437W (R6 / 5-06) �
Prescnbed by Depanment of �oral Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor o/ the county where the prop is
Filing Dates: 1J Real PropeRy: Dunng the 12 months be/ore dune Il o( the year the deduction is to pe lfectiv�e.
2) Mobile Homes assessed under IC 6-7. 7-7: Between January 15 and March �l�e�;�e�r�th�e�beduction is to be elfective.
See reverse srde fo� additional instnictions and qual�cations.
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Applicant
Dislrict
Assessed vatue of ree
March 1, curtent year
see res{riG�oRS qh reverse
description � Record number
�1/ _I � I ��../ (O''MO. P e ber �
�(l9 �¢'- 4- W
of Mortgage / Contrad indebtedness unpaid as of Is e applicant the sole legal or equitable
March 1, currenl year ownef? ❑ Yes ❑ No
is his / her exact share of interest?
If owned with someone olher lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below:
e of moAgagee or contrad seller
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Address of mortgagee or conVad seller (number and st e city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, s[ate, ZIP code)
Dces applipnt own property in any
county in Indiana?
Deduction approved in the amount of:
20
Signature
Is the property in question:
❑ Real PropeAy ❑ Mobile Home pC 61.
If yes, what county? I What Tauing Distrid? Has this deduc[ion been requested on
-----`� for current yeaR� Yes❑ No
Di•a��•er ��•.��y•......
Card NO• • 4?•1� �........
-� -� 3�,qy�.
Za �_ � 20
County Auditor
Date
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certify under the penalty of perjury that the above and toregoing information is true and corred and lhat ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ire (own s(ull name) Person authorized by duly executed Power of Attomey
^�OQ � � � n or by IC 6-1.1-12-.07
residenl �dllress of applicant
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