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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 637W (RS I 6-03)
Prescribed by Department ot Laal Govemment Finance
Coun Township Year
'. 1 � ''� '� �-1 T^�
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INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the County Auditor of the county where the property is located. [[�+ Q 3 2��4
Filing Dates: 1J Real Property: During the 12 montbs before May 11 o7the year the deduction is to be eh�ctl�e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0) the year the d�dudion is to be effective.
See reverse side Ior additional instructions and qualifications. �.��L �y 2�� ;:�.'
„ GIBS0�4 COUVI r tiU.:�1UE.
Applicant (owne�
Taxing
Assessed value of real property as of
March 1, current year
restrictions on
no, what is his / her exact share of interest?
Key number / legal description
number
O/ �5 _ /-i0 �3/ �T1 Page number
(/ v (� `�lJ
MoRgage / Contrad indebtedness unpaid as of Is the a
March 1, current year owneR
If name on record is different than thaf of applicant, indicate below:
of mortgagee or contrad seller
�� �
/sa
I the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or conVact seller (number and sbeet, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20
Signature
20
❑ Real Property ❑ Mobile Horne QC 61.1-�
If yes, what county? � What Tarin� n�«^�' Has this deduction
property for curcent
Drawer NO. �y' �S� ��
CardNO . .....................
� . 20�_ 20�D 20
�p � P
County Auditor Dat
20
iested on
Yes � No
We certiy under the penalty of perjury that the above and foregoing infortnation is true and coned and that ihe applicants was / were
resideni of Indiana and owner of the aforementioned property on March 1, 20
Person aulhorized b�
or by IC 6-1.1-12-.07
Address
�.
executed Power of Attomey
person