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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 437W (R6 / 5-06) �
Presvi6ed by �epartment of Local Govemrtmnt Finance
INSTRUCTIONS:
To be filed in pe�son or by mail with the County Auditor of the county where the prope�ty is located. 7 Zo� 7
Filing Dates: 7) Real Property: Dunng the 12 months before:,lune 11 of the year the deduc6on is to be ��ive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year� -thye�deduction is to be elfective.
See reverse side for additional instructions and quali(rcations. �/'��'6�
GIBSON COUNTY AUDITOR
Appli t(owner or contract buyer- see tdclions on reverse side)
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Taxing Dislrid Key number / legal description Record number O
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, currenl year ownef? ❑ Yes ❑ No
95, sD�- � '
If no, what is his / her exad share of interest? If owned with someone other ihan spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate below: Is the property in question:
❑ Real Propaty ❑ Moble Horrre (IC 61.1-�
me of mortgagee or contract seller `����'�',
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Address of mortgagee or contract seiler (number and street, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand stree
Does applicant own property in any othe �0(,1 NQy ����{.�j�peK �Q- �i,ttP j :d on
counry in Indiana? l � '❑ No
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Deducfion approved in the amouni of: ty � Q� /,JS SU �
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Signature ` 1 I � �� �
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We certify under the penalty of perjury lhal lhe above and foregoing information is true and corred and that the applicants was were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (ownels /ull name) Person authorized by duly executed Power of Attomey �
�� � or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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