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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, FOR DEDUCTION FROM ASSESSED VALUATION
• State Form A37W (R77 / 6-09)
�' ,,,, ` Presaibetl by DeP��rd o( LoW GovemmeN Fuarce
File Mark
iNSrRUCnorvs:
Fam f�ed wiN:
To 6e (led in person w by mail with fhe Counry Auditor or Counry Recorder o( the aounty whele fhe pmperty is located.
Fil'mg �ates: 1 J Real Property: Must 61e durirg the year tor which Ihe deductlon is soughG q�d���
2) Mobde / Manufactured Homes rat assessed as Real Property Must file during the lwelve (12) s�
betoie Ma�ch 37 ot each year the deduclion is soughL C n emder
See reverse side tor adtliUOnal instructions arM qualifications.
MWcant(owr�erwconnart -=ewresvicnasonrCrerse S� / �l�/1% . ~� fi � �011
�a�truY � - KeY�wm6er/Ieg-ldeSaiWion '
/ O
Assessed We U 2al P a d Mongage / Contract trdebteC
Ma�Yh 1. ¢rrent yrar Ma�ch 1. m
If no, what 5 his / her ern2 shara oi interest?
If rwne m mmN a di(terent Ihan Nat of app4ant, uWica[e Gebw.
Name of rtartgagee or trarl sHler ,/� � A ,
V ,( �•�
ACCress of nnrtgagee a oontrad se0er (mm6ei errl streeG rd}: state, arrtl ZfP
Name o( assi9nee or oihu owner or holder ol morigage
Oces apyi`aM ovm propttly in a�ry other
munry in Ind'ena?
❑ Yes
DeducUOn approved'o� ihe amouni of.
20 20
sy�awre wc�,n9�W��c � n .
tt owned with sortiew�e dher tlan spouse, iMkate wifh whom
cnY, sfate. ana /.( ���� n " � • ' _ _
�� C�CJ�
o No do i�-as� o
I/ We certify under Ne penalry ot perjury that the ve and fc
owner I contract buyer of Ne a(orementioned pro on date
3^�R (owners NU name, /O
dty, state. antl LP code)
� asv w
Dy O�dy executed Power of Mmrey rn by
Pddress of auNrn'ved person (number aM SLeet. cily, sfate, and ZlPmde)
ltade ovrt�el.+
Yes ❑ No
I5 Cre pmpenY �^ Vues�tiac M��aRY AsscsSed
❑ R2a� Pfopefly ❑ AM11311y ASSCSSP,�
�����������,o�
br aurent YP�! ❑ Yes ❑ ,
�
20
(����er� ���5`� ay-�/
umation is We and correa and that the applirant is a resident of Intliana aM
Ls filed. . . .
Date (monfh, day, y�ea�
��,�,�Y �