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"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 037W (R11 / 6-09)
�' d Presaibed by Departrnent of Local GovemmeM Firence
F
INSTRUCT70NS: 1I podEru�e�rtn
To 6e Red in person or by mail with fhe Counry Auditw or Counry Recorder o/ the county where the pioperty is IocatedJYl�iR V a L u 1 I�
Fifirg Dates: 1J Real Property: Must file dunng Ne }rear (or which the deduclion is sought. Counry Audimr
2) Mobde / Manufactured Homes rrof assessed as Real Property Must h7e dunng the fwelve (12) month� .�,
before Maich 31 of each year Ne deduction is sought . ounty Recorder
See reve e side (or addiLOnal instructiw�s antl qualifications.
MpGp perorconuaa6tryer-seeresvirlionsw�+eversevde) � � �_
�ee�rn� �-/a.-iP- 3od -oo/. [�45- aa8 2�O1� ]r32-
f real propeny as N Mortaage / Contraa We6tedness unpaW es d Mangage 1 ConbaG'vMeMedness unpaid as of Is Ne appGrani the soie
ymr MaRh 1, arten,t�"�� Oate of application legal or epuitable owneY?
�Q]'/ n�Q ❑Yes ❑No
tt no. what Is Ili5 / her e�tad sitare ol utNn
If rwne an �d a Ettierent fhan Mat of �
Name N rtiortgagee or mntract se0er
Pdd2a of rtnrt9agee w cmtrad se0er p
Name af assi9nee or oiher ovmer m Imldi
Adtlress of ass,gice (rwmher and stree;
Does applimn[ own property in any othel
munry in Ind'ana? ❑ Yes
Deducliw app�avcd'ui ihe amouN oF.
� p_
uitliCa[e Delow.
sOee4 u�l: sbtB.
rdy, slafe. aM LP catle)
8' ��
If yns. what munfyl
❑ No
�
�
If avmed with someone oNer ihan spouse.'uMicate with wfiom
I5 perty in puestion: MnueOy Assrssed
eal RoPertY ❑ MnUallyAsSessed
Wlat Taring Dist+ict? Has ih"a deductian Dcen reQueslrL m propeny_�_
for a.mv� m�n_ —' _
,�u� T R�� �
nuorrort S/IQl� /�
�° � aor�- /���
��anrteo CamryAUd' — Ca�N .
I/ We certify uMer the penalry of pe � that the above A foregoing intortnation is We and corteG arW that Ne applinnt �s a resident of IrMiana aM
owner / mntract buyer of the aforem � ed mperty date application is filed.
�reW o Mlrame) ��(/��.�Y.Y��
il rev t adtlress of appfrcan (num6er a sLee4 �}fe, antl ZIP code)
/ Sz ��' /%7�1/•�J S T. %!�/.i/C�To.v 1r.✓ 5� 2� ? U
rson autlrorired by tlury exewted Power of Auwney or by IC 61.1-12-0.7 � �ate (rtronN, day, yee�
person (number aiW street �ry. sYafa,