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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
f FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
• �_«. / State Form 637W (R514-03) . ��1 r � .� ��' � � 1�'
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� � Prescribed by Department of Local Govemment Finance �,�'i 5 j� 3 ' N �{ J
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INSTRUCTIONS: ��� �FilefotaYK
To be filed in person or by mail with the Counry Auditor of the counry where the property is located. �, //
Filing Dates: 1) Real Property: During the 12 months before May 11 o/the year the deduction is to be"ef(ective.�{ � (�/J� f/
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the�year4he deBu'ction'is`tobe:eflective.
�" Gi°SGid GC J�2 t Y. w. w.� �
See reverse side for additional insGuctions and qualifications.
(ownerorcontract 6uyer-
Taxing Distrid
restnctions on reverse side)
Key number / �egal description
� o _�
Assessed value of real property as of MoAgage / Conhacl ir
March t, curcent year March 1, wrrent year
If no, what is his / her exact share of interest? �
If name on record is different than lhat of applicant, indicate below:
mortgagee or contract seller
number
Page number
as of Is the applicant the sole legal or equitable
owneR �s � No
If owned with someone other than spouse, indicate with whom.
Address of•mortg�qee or contraIX seller (number and sfreet, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
20
Signature
approved in the amounl of:
20
Is the property in
❑ MoGle Home (IC 61.
What T
Drawer NO� y. •• �/••�
COUNTY AUDIT(
20 Q`� 20 O q 20
� P
County Auditor
CardNO . .....................
20
20
ted on
s � No
certify under the penaity of pe�jury that the above and foregoing infortnation is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person