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STATEAAENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�'+ `' ! Siate Fortn 437W (R5 / 4-03)
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� PfescriDed by Depanmeni of Local Govemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 monfhs before May 11 0/ the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the year the deduction is to 6e eHective.
See reverse side !or addifional instructions and quali�cations.
Applicant (owner
Taxing
-see
Assessed value of real property as of
March 1, cunent year
if no, what is his / her exact share of interest?
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^O��[�� � Pagenumber
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Mortgage / Contrad indebledness unpaid as of Is the applicant the sole legal or equitable
Marchl�current year owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
name on record is different lhan lhat of applicant, indicate below:
of moAgagee or contract selier
Address of mortgagee or contraG seller (number and tre t, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliwnt own property in any other I If yes, wn��-- �ry? What Taxing District?
county in Indiana? �_ -- 6•� �7y � �
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vTV auoiroR
DeductionappaT�]iv�• • -.
20 _Q� _ 20 �� 20 2� 20 ��
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Signature County Auditor
❑ Real Propsty ❑ Mobile Horrre pC Crt.
Has this deduqion been requested on
property for current year? � YesO No
20 �
Date �
20
/ We certify under lhe penalty of perjury lhat the above and foregoing intormalion is true and corred and that the applicants was / were
resident 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
ress of applicant Address of authorized person
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