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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
StateForm437091R514-03) ;p.........p�,,,"M1,;.� .^ ,N. , -': ,
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Prescnbetl Ey Department of Local Govemment Finance � � �
INSTRUCTIONS: - �- - � - � • - � •
To be filed in person or by mail with the County Auditor o! the county whe2 the property is
Filing Dafes: 1) Real Prbperty: Dunny the,;12 months beforo-'May f l,of the year the;deduction is to 6��c1�e1 20Q6
2J.Mobile Homes�assessed under IG6-1J-7:.Between Janua 15,and March 2 of the. e deduction is,to be effective.
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See reverse side for additional insfructions and qualifications. ;�� } • ... -
Applicant (owner
see
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Assessed value of real property as of
March 1, curcent year �
no, what is his / her exact share
If name on
Key number / legal
✓"�G� V
,... �n�INTY AUD170R
Record number
/� / � _O � O �� Page number � / � �
V
Mortgage / Contred indebtedness unpaid as of Is lhe applicant the sole legal or
March 1, current year ownef? ❑ Yes ❑ No.
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ihan that of applicanl, indicate below:
mortgagee or contreIX seller
Address of moRgagee or contrad seller (number and st2et, city,
Name of assignee or other owner or holdeF of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
county in indiana?
owned with someone other than spouse, indicate with whom.
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What Taxing District?
`'^""T" '1UDITOR
Deduction approved ir
Dra�� er NO...°..�...�J...........
20 � '� l 39
� Card NO . .....................
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Signature
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> ihe property in question:
❑ Real Property ❑ Mobile Hane
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Has this deduclion been requested on
property for wrrent year? �] Yes ❑ No
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Date
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certify under the penalty of perjury that lhe above and foregoing information is true and corred and thal ihe applicants was / were
ent of Indiana and owner of the aforementioned property on March t, 20
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Pull resident address o(
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
authorized person