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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Folm 437p9 (RS / 4-03)
Coun Township Year
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� PrescriCed �y Departmeni o( local Govemment Finance T
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INSTRUCTIONS: File MaJ�
To be filed in person or by mail with the County Auditor of [he counry w6ere the property is lowted. SE� U° �°�4
Filing Dates: 1) Real PropeRy: During the 12 months be%re May 11 0/ the year the deduction is fo be e ective.
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 0/ the yea�the deduction s'to be effectiv'e.
See �everse side for additional instructions and ualifications. ''"�� J`� ���•
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Applicant (ownerorcontract 6uyer- see restnctions reverse side)
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Taxing DistnCJ�� Key number / legal description Record number O LI —/ a��
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Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant thP/sole legal or equitable
March t, current year March 1, current year owneR �Yes ❑ No
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Ii no, what is his / her exad share of interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
❑Real Property O Mobile Horrre (IC 61.1-�
��ne of mortgagee or contraIX seller �
P;ddress of mortgagee or contract seller (number d street, city, stale, ZIP
Name of assignee or other owner or holder of mortgage '
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Address of assignee (num6er and st�eet, city, state, ZIP code)
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Does applicant own property in any other If yes, what county? What Taxin istrid? Has this deduction been requested on
county in Indiana? property for wrrent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in lhe amount of:
20 O� 20 �� 20 �� 20 0� 20 20 20
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Signature County Auditor Date
We certify under lhe penalry of perjury lhat the above and foregoing information is true and corred and that lhe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
S� na re (owner's /ull name) Person aulhorized by duly executed Power of Attorney
� - - or by IC 6-1.1-12-.07
F II resident address of a pli nt Address of authorized person
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