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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 637W (RS / 4-03)
PrescriCeO by Department ol Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where the property is located. qNK )�j' 20�4
Filing Dates: 1J Rea/ Property: Dunng the 12 months 6efore May i f ol the year the deduction is to be effec6ve."
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eHective.
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See reverse side /or additional instructions and qualifications. ._,,,,'.�y,�,�
. . � _.�'•�, v SUD:TCR
(owner
/ �
Assessed vafue of real property as of
March 1, current year
no, what is his ! her exad share of interest?
reverse side)
Key number / Iegai description Record number
CJ '`�
0��1 _ O'l I 3 I" iJ� Page number �` �
1 O� `v
Mortgage / ContraIX indebtedness unpaid as of Is the applicant the ole legal or
March 1, currenl year � owne(? �s ❑ No
da9a�d
If name on record is different than that of applicant, indicate below:
�ame of mortgagee or contrad seller 5/�
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or wntred seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sbeet, city, state, ZIP code)
Does appliwnt own property in any
county in indiana?
Deduction
20
Signature
in the
20 �
/ We certify under the
� rgsident of Ipdian�
If yes, what county?
COUNTY AUDITOR
20 � 20 ��
P
County Auditor
Is the
❑ Mobile Hame QC 61.1-
Drawer 1�0. �+�%
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Card�N�OQ, ��y �
, . auested on
I V��N��.� ,... ---. _ _ � Yes❑ No
20 �_ 20 _
�
Date
20
of perjury that the above and foregoing information is true and corred and that the applicants was / were
r\f the aforementioned property on March 1, 20
resident address o
RR2 , Qo
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person