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/� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION ou n'p Year
-y State Fortn 437W (R6 / SO6) � '
Presaibetl by DepaNnert of Lofal Govemmenl Finance
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INSTRUCTIONS: �� ��le Maric
To be filed in person or by mail with the County Audifor of the county whe�e the p�operty is located.
Filing Oates: i) Real Property: Dunng lhe 12 months 6e(ore June 17 of the year the deductior���� 6@lttlHYg. AUDITOR
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the year the deducUon is to be elfective.
See reverse side (or additional instructions and qualifications.
App�ic�n (owner or conhact bu e- see restrictions on reverse side)
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Taxing Dislri Key number / legal scription ' ' Record number y Q Q' -7
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�t�` �L�r���� a(o �8'�.�_�y"U,j-00�-,$38-J� Pagenumber�33 �
Assessed value of real property as of MoAgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
7��500
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom. '
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If name on record is different lhan that of applicant, indicate betow: Is lhe proPerty in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
me of moAgagee or contract seller /�
�I , , ; .
Address of mortgagee or contrad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage � �. �
Address of assignee (number and streef, city, state, ZIP cod� �(� � � f> �1�r7�
Does applicant own property in any other If yes, what county r�V I �
county in indiana? !]-, � �
'V
� ��p'7-333`�
Dedudion approved in the amount of:
20 � 20 � 20 � i'! � I �� a�j
I
Signature County A.,anor -
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners lull name) Person authorized by duly executed Power of Attomey
M or by IC 6-t.t-12-.07
F�I�resi en ddress of ap ipnt Address of authorized person
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