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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S w� / SHte Form 437W (RS / 4-03) � . '
�� Prescribed by Departmem of Local Guvemmeni Finance
To beRfiled�ln�person or by mail with the County Auditor of the county where the property is locate� � L/ �a�
Filing Dates: 1) Real Property: During the 12 months be)ore May 11 0! the year the deduction is to be efiective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(the year�5�e�u�'a�8� be effective.
See reverse side /or additional insfructions and qualifications.
Taxing Dislrid �
�/�" "`-�'1 "
Assessed value oi real property as of
March 1, current year
no, what is his / her exact share of interest?
Key number /
��J�-O�4 9 9�� Page number / L+�
J
Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cur�r/ent year owner? ❑ Yes ❑ No
3( D
If owned with someone other than spouse, indicate with whom.
If name on record is different than Ihat of applicant, indicate below:
�e oi mortgagee or contract seller
Address of mortgagee or contract seller (number an str et, city, s
of assignee or other owner or holder of mortgage
(number and s6eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amouni of:
20 20 � 7 20
�P P
Signature
. aoo�� a9s
the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
Drawer NO: Q�;;���(O
Card NO. ...:.. `
...............
What Taxing District? Has this dedudion been requested on
property for current yeaR � Yes � No
COUNTY AUDITOR
20 fJ�_ � 20
� I P
County Auditor
20
Dale
20
certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March t, 20
full
address of applicanC
Q9 Yna,y ��
Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
of authorized person