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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sute Fwm 63709 (RS / a�3)
Prescribed by Department ol Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
File Mark
To be filed in person or by mail with the County Auditor o/ the county where the property is located. FEB 0 9 Z��S
Fiiing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yeaL(b�edysc�ipn is to be effective.
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See reverse side for additional instructions and qualifications. (/
GIBSON COUNTY AUDITOR
6uyer-see
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Assessed value of real property as of
March 1, curtent year
If no, what is his / her exact share of interest?
side)
Key number I al de�cription Record number
00 � / � (? � � Page number ��
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MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
wunfy in Indiana? �- _ �
Deduction approve
20
Drawer NO.... �.. . -
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County Auditor
What Taxing District?
,UDITOR
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Is the pi
❑ Real
in question:
❑ Mobile Home (IC 61.
Has this dedudion been requested on
property for currenl year?0 Yes❑ No
20
Date
20
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We certify under the enalty oi perjury that the above and foregoing informalion is We and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power oi Attorney
or by IC 6-1.1-12-.07
> of applicant ` �Address of authorized person
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