HomeMy WebLinkAboutMortgage_Riley (4)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
�• � «• J State Fwm 437W (RS / a-03) . � .
� PresaiDeO Dy Department of Local Govemment Finance
Coun Township Year
INSTRUCTIONS: APR O �ilg�k
To be filed in person or 6y mail with the County Auditor ot the county whe2 the property is located. LUU�
�,Filing Dates: 1) Real Property: During the 72 montbs before May 11 of the year the deduction is ro be effective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year to be effective.
See reverse side (or additional insWCtions and qualifications. 6188AN QQ��'y q Bifi@�
l�- l�3 - �a- �3c� cr;� a b5 -�ao�
Applicar}f (�i er or contract buy�- �eaestnctiQns n �ev�rse side)
Key number�l�gal description ( Record number
/ .,/��� . / .� � /)/1� " il/") �/�� dU Page number / n��
��lJ � C�L`/ C�C.Y[e 7
Assessed vatue of real property as of MoRgage / Contrac/t 1indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, current year March 1, currenl yea� owner? ❑ Yes ❑ No
CO
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
name on
than that of appiicant, indicate
moAgagee or contract seller
Address of mortgagee or contract seller (number and street, city,
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and street, ciry, sfafe, ZIP code)
ZIP
Does apF --`-? What Taxing District?
county in Drawe a coS
r NO.. f�:+.�;-� �. �/. �S
Card 1v0. .,
• • • • • • •.... :OUNTY AUDITOR
Deducti .
20
Signature
20 ,� %
��_.
�
20 ___p g_ 20 �� 20
P P
County Auditor
s the property in question:
❑ Real PropE�rty ❑ Mobile Home pC &1.
�
Has this deduclion been requested on
propeRy for current yearl �] Yes � No
20
Date
20
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person