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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION n w hi Year
�'• w� ✓ Sta:eFOrma37W�R5/a-03)
� PreSaibed Dy Department ot local Govemment Finance �� ^00 `
NOV l., c •�
INSTRUCTIONS: e Ma
To be /iled in person or by mail with the County Auditor ol the county where the property is loca � � Ty .AUDITOR
Filing Dates: 1) Real Property: Dunng the �12 months before May i 1 of the year the deduction td��ch �.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is to be eRective.
See reverse side for additional instructions and quali�cations.
(owner or co�act buyer- see
�
value of real property as of
March 1, cunent year
If no, what is his / her exact share of interest?
on reverse side)
Key dumber / legal description
U I �}-�18 I-
MoAgage / Contrad indebfedn
March 1, current year
-74.50d
name on record is diHerent than lhat of applicant, indicate below:
of mortgagee or contraIX seller
Record number
Page number
unpaid as of Is the applicant the sole legal or
owner? �1Ji es ❑ No
If owned with someone other lhan spouse, indicate with whom.
of mortgagee or contrad seller (number and street, city, state, ZIP
assignee or other owner or holder of morigage
Address of assignee (num6erand street, city, state, ZIP code)
Is the,Property in question:
tf�lReal Property O Modle Hane (IC 61.
Drawer NO ..:................
Card NO. .�.a�Vl........
� 7y, 5�. �
Does applipnt own property in any olher I If yes, what county? What Taxing District?
county in Indiana?
Deduction approved in the amount of:
20 20�_
1
Signature
COUNTY AUDITOR
20 �_ 20 � 20
� �
County Auditor
Has thls tl2tluCtlOn b0ef1 fOqUBSted On
property for current year?� Yes❑ No
20
Date
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
fent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person