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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
� N� ! SUte Fwrt:437W (RS 14-03)
�PresrnEeE 6y Department of Loc�al Govemment Finance ^
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INSTRUCTIONS: �� �
Coun Township Year
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4"� Fite Mark
To be �led in person or 6y mail with the CountyAuditor ot the county whe2 the p�opeRy is loca�ed, �� �(j04
Filing Dates: 1) Real Property: During the•12 months be(ore May 11 of the year the deductrid'i�is to be ef`�ect�ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year"the deduction is to be effective.
See 2verse side for additional instructions and qualifications. k�� ��1 U',/��„s�
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Applica t(own or contract 6uyer - see rGstnctio on erse side)
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Taxing Distrid Key number / legal descripti Record number
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Page number
O/3-oo330-�
Assessed value of reat property as of Mortgage / ConlraG indebtedness unpaid as of Is the applicant, —th,!e'sole legal or equitable
March 1, current year March 1, current year owneR LN'res ❑ No
,3d Od�
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 different lhan that of applicanl, indicate below: Is the property in question:
❑ Real Propeity p Mobile Hmre (IC 61.1-�
��ne of mortgagee or contract seller �/
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Address o� mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher If yes, what couniy? What Taxing Distrid? Has this deduction been requested on
county in Indiana?- property for wrrent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 �� 20 �� 20 Q� 20 20 20
P P P
Signature County Auditor Date
� We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal the applicants was / were
:sideni of Indiana and owner of the aforementioned property on March 7, 20
Signatu (ow er full na e Person authorized by duly executed Power of Attomey
' or by IC 6-7.1-12-.07
Futl resident address of applicant Address of authorized person '
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