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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township vear
�'. ! Sia;a Form d37W (R51 a-03)
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PrescnOeE by Departmem of local Govemment finance
INSTRUCTIONS: File Mark
To be filed in person o� by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 0! the year the de uction is to be e/%ctiv
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 an M h 2 o)t e year the ction is to be ef/ective.
See reverse side !or additional instructions and qualiCcations. ����
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Applicant (owner or con�act �uyer - see
side)
MAY 0 3 Z005
Taxing Dist 'd - Key number / le�al ct JRQft� Rewrd numbef—y„ 4�
�l O'�a �
Q� .,� �Q Q 7� V Page nur�SH$r50N COUNTY AUDtP�Q
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Ass ssed value of real prop y as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or E
March t, wrrent year Alarch 1, wrrent year � owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate belo
time of m�_rtgagee or contract seller
T�•
Address of mortgagee or contract seller (nu er and street, city,
assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, slate,
Does appiicant own property in any other If yes, what county? I What Taxing District?
county in Indiana?
Deduction approved in the amounf of:
20 � 20 �7
�
Signature
COUNTY AUDITOR
20 �� - 20
County Auc
20
Is the property in queslion:
❑ Real Property p Mobiie Home (IC 6-1.
Has ihis deduction been requested on
property for current year?� Yes� No
�
20
i -
We certify under the penalty of perjury that the above and foregoing information is irue and correct and that the applicants was ! were
resident of Indiana and owner o(the atorementioned properfy on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07 '
of authorized person