HomeMy WebLinkAboutMortgage_Couts`° R�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-- � FOR DEDUCTION FROM ASSESSED VALUATION
S � State Fortn 437W (R4 / 1P-01) . �
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� PresaibeE by DepaNrenl W Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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To 6e filed in person or by mail with the County Auditor of the county where tbe propeRy is located. �� ��3
Filing Dates: 1) Real Property: During the 12 months be%�e May 11 of fhe year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year the deductin�r,is to b�Lec �eHe�ctive.
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See reverse side /or additional inst�uctions and qualifications. + Y AUDIT�a
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Applicant ner or contr�ct bu rn- se^e _re^sfnctions on reverse si e)
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Tax ng Dislrid Key number / Iegai description Record number �
(�,����;v1'Y��-� �03-0 o a D3 -� Page number �,/ ,!
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, ent year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is differenl than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
''ame of mortgagee or contrad seller �
Address of mortgagee or contract seller (number and reet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent yeaR� Yes❑ No
COUNTY AUDITOR
Deduction appraved in the amounf of:
20 20Q� 20 20 � 20 �� 20 �$_ 20 �_
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Signature County Auditor Date
�/ We ceAify under the penalty of perjury thai the above and foregoing infortnation is lrue and correq and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si natur�wners full nam ) Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
II resi en a ress of pplicant Address oi authorized person
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