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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION
�• �w� ! State Form a37p9 (RS / a-03)
� PresaiGed �y Department 01 Lofal Govemment Finance
INSTRUCTIONS:
To be )iled in person or by mail with the CountyAUditor of the county where the property is located. �/� V 9 20�5
Filing Dates: 7) Real Property: During the 12 monihs be(ore May 11 of the year the deduction is to be et�flve.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be eftective.
See reverse side !or additional instructions and qualifications. a� ��.vi�
GIBSON COUN� q(JpITOR
Applicant
Taxing DistriG
side)
Key number / legal description
-�o a�-�Q6-66o.asr-�.
Record number �
I_ �,/j� ,\I wn/� Q I _ � 1�QU Page number
�-�.cti�C.V � � �
Assessed value ot real propeAy as oi Mortgage / Contrecl indebtedness unpaid as of Is the applicant the sole le I or equitable
March i, current year March 1, current year ��� owner? ❑ Yes ❑ No
1
If no, what is his ! her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appliwnt, indicate below:
ot mortgagee or contrect seller O�_ � O��
Address o( mortgagee or contracl selb
� ��i
�� s-9-�.� �
G U
Name o( assignee or other owner or Y /�„��c
� �'i>�s Uo,�.y
Address of assignee (numbe� and st2er, a�y, ��e�e,-�.,_.,.�_�
s the property in question:
❑ Real Property ❑ Mobile Home (IC G1.
Ooes applicant own property in any other I If yes, what county? What Taxing District? Has this deduction been requested on
wunty in Indiana? property for current year? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 20 �� 20 09_ 20
-P � P
Signature
Couniy Auditor
20
�
20
ify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
of Indiana and owner oi the aforementioned property on March 1, 20
of
i
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
� of authorized person
� 613