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i�'' �, STATEMENT OF MORTGAGE OR CONTRACT IN�EBTEDNESS
�i�; FOR DEDUCTION FROM ASSESSED VALUATION a� Year
4.... M. -�' State Form 437C5 (R6 / 5-06) �- G
� Prescribed by Department of Loni Govemment Finance �d�
JUL 2 5 2007
INSTRUCTIONS: File Mark
To be filed in person, or by mail with the County Auditor of the county where the property is located. �p-y�,!, �Q
Filing Dates: 1) Real Property_ During the 12 months 6efore June 1.7 of lhe year the deduction is to be e�(fect� �
2) Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 of t��S�NileQ1�P1��ti61U���� eRective.
See reverse side /or additional instructions and qualifications.
�
Assessed value ofreal
March 1, current year
If no, what is his / her exad
of
of interest?
on
iCey number / Iegal description �/� Record number O� _
'"�-�v'�/�-�/� " Pagenumber n��/
�
MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year / owneR ❑ Yes � No `
If dwned wifh someone olher lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
i .✓.L
❑ Real Property ❑ Mobile Horne (IC Cr1.
�me of mortgagee or contred seller � ' ', _
�.. �.
Address of moRgagee or contract seller (nu er and street, city, state, ZIP �R ����� �� �011��s
Name of assignee or other owner or holder of mortgage M�1 �GA� Er �'
Address of assignee (number and street, city, state, ZIP
Does applicant own property in any other If yes, what county?
counry in Indiana?
Deduction approved in the amount of:
20
Signature
20
�a_8���
What "i axing Distrid?
COUNTY AUDITOR
20 20 20
County Auditor
Has this dedudion been requested on
property for wrtent yeaR � Yes❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
esidept of Indian�d owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
� I rmi resiaem aaaress ot appucant Address of authonzed person
37 � �n„ne Un