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i i� STATEMENT OF MORTGAGE OR CONTRACT INUEBTEDNESS
'i' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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�•• Resoihed by Department of Local Gwemment Finance
INSTRUCTIONS: File Mark
To be /iled in person or by mail with the CountyAuditor of the county whe�e�the propeRy is located. � � r I � ZOO)
Filing Dates: 1J Real P�operty: Dunng the 72 months before ,lune 11 of the year the deduction is to be effec[ive.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the year the�c6on j;�be elfecfive.
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See reverse side lor additional instrucfions and qualifications. GIBSON U
COUNTY AUDITCR
Applicant ( erorcontracf buyer- see restridions o� vers�e /side)
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Taxing Dis(iid Key number / legal description Record number �� U �
, /�.� , t—T-� �I -�D -D�(-.3US'Ol�OvO / Pagenumber � � a3
��G�L(/Li
3
Assessed vafue of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? I( owned with someone olher lhan spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate betow: Is the property in question:
�me of moRgagee or nUad selier �
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Address ot mORgapee or contract seller (number and stieet, city, state, ZIP
Name of
Address
or other owner or holder of mortgage
(num6erand st2ef, city, state,
Does applicaM own property in any other � If yes, what county?
county in Indiana?
Dedudion
20 ��
1
Signature
20
the amount of:
�
❑ Real Property ❑ Mobile Home pC 61.
Dra�ti�er N.O�Q� %, �,���
Card Np, "
��c�ar � �.........
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What Tauing District?
COUNTY AUDITOR
20
County Auditor
20
, .U�
Has this deduction been requesied on
property for curtent year?Q Yes❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
esideni of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Atlomey
or by IC 6-1.1-12-.07
'esiG(�e'nt address oT applipnt Address of authorized person
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