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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
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� PrescnEetl by Department of Local Govemment Finance
Coun Township Year
INSTRUCTfONS: F1',I ,[� rk
To be filed in person or 6y mail with the CountyAUditor of the county where the property is located. MAR 1 4[�U/
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 of the year the deduction is to be eHecfive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the yearl�aded�s to be eNective.
See reverse side for additional instrucfions and qualifications. �� Q �
GIBSON COUNTY AUDITOR
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Taxing istrid
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Assessed value of real property as of
March 1, curzent year
on reverse side) s
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Key number / legal description
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Mortgage / Contrect indebtedness unpaid as ol
March 1, currenl vger
Record
Page number
Is lhe applicant the sole legal or equitable
owner? � Yes ❑ No
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
0 - S3
I( name on record is different than that of applicant, indicate below: Is the property in question:
❑ Rea� PropeAy ❑ Mobile Home QC 61.1-�
�me of mortgagee or conhad seller
G C— � imber and st2et, city, state, ZIP
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^ � I/ �� / � of mortgage
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�„�, e,,, %n{� �� 1 OOd• � o y, state, ZIP code)
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1
Ivoes appllcant own property in any other If yes, what county?
wunty in Indiana?
Deduction approved in the amount of:
20�� 20
P
SignaWre
What Taxing Distrid? Has this dedudion been requested on
property for current yea(? � Yes� No
COUNTY AUDITOR
� 20 Ol 20 20
P� � P
County Auditor
20
20
We certify under the penalty of perjury that the above and foregoing information is Irue and correct and thal the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
� Si�ure (owners lull na e) •
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Full resident address of appiicant
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07 �
of authorized person