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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 037p9 (R5/4-03) '
� Prestnbed by Department ot Local Govemment Finance
INSTRUCTIONS:
To 6e (led in person or by mail wiih the County Auditor of the county whe2 the property is located. NU �`� 3'I���F
Filing Dates: 1) Real Property: Dunng the 12 months be7ore May 11 0! the year the deduction is t eNective.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ t year the d u � n is to e e ctive.
See reverse side fo� additional instructions and qualifications. GI830N COU Ty
AUDITOR
value 61 real
March t,
- see
Key nurrJF�r / legal
Record number
� �%n� O�Q //— d� Page number V
� `lhJ �
of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest?
owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�ne of mortgagee or contraIX seller
vr��
Address of mortgagee or contrad seller (numbe� and st2et, city, state, ZIP
Na -'— -^• �vher owner or holder of mortgage
A� Drawer NO.. p� IPcode)
.. .y.......
° Card n'p, �.3(a 9 ,c ���y?
� ��a�,�........
Deduction approved in the amounl of:
20 � I 20 �
�
SignaWre
What Taxing Districl?
COUNTY AUDITOR
20 �� 20 Q� 20
�
County Auditor
s the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
property for wrrent year? � Yes ❑ No
20
20
certify under the penaity of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
lenl of Indiana and 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
Fuil resident address of applicant Address ot authorized person
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