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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 437 W(RS / 4-03)
PresaiEeC by Departmeni of Loral Govemment Finance
Coun Township Year
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INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the Counry Auditor of the county where the property is located. � l. 1(J j 1Q03
Filing Dates: 1) Real Property: During the 12 months before May i 1 0/ fhe year the deduction is to be e9ective.
2) Mo6ile Homes assessed under IC 6-1.1J: Between January 15 and March 2 of the yea the deduction is'ta be el/ ctiv .
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See reverse side for additional insWCtions and qualifications. � GBSON�r �
COUNT4' qUDITOR
Applicant (owner or contract buye - s restric�ons on r vers ide)
Taxin trid Key number / al descrip n Record mber �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, currenl year March 1, current year �5 O O C� O. ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is lhe property in quesiion:
❑ Real Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or conlrad seller ��
Address of mortgagee or contrad seller (number and st2et, 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 county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
�'/ We certiy under lhe penalty of perjury that the above and foregoing information is true and corred and lhat lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si (owners full nam�]„� Person authorized by duty executed Power of Attomey
�� 71 or by IC 6-1.1-12-.07
Fu resident a r s o applicant Address of authorized person
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