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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �w / State Fortn C3709 (RS / 4-03) � � �
Prescripetl py Department of Local Govemmani Financa
INSTRUCTIONS: SEP �ile M�iKs
To be filed in person or by mail with the Counry Auditor o/ the county where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 monfhs before May 11 of fhe year the deduction is to be eflec( vi e;� �,Q�,
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is !(^0 6e elfective.
See reverse side for additional instructions and quali�cations.
GIBSON COUNTY AUDITOR
(owne� or contracf buyer- see restridions on reverse side)
Taxing District
Assessed value of real properiy as
March 1, current year
Key number / legal description Record number
�G-�%e'-.io3 - 000• �4? aa�
1 Page number 1
�\� ~ �� � \
Mortgage / Contract indebtedness unpaid as of Is the applicant he sole legal or
March 1, current year owne(? s❑ No
If no, what is his / her exaa share of interest?
If name on record is different than that of applicant,
ie of
Address of
or contract seller
below:
If owned with someone other ihan spouse, indicate with whom.
or contrad seller (number and streef, city, state, ZIP
of assignee or other owner or holder of mortgage
of assignee (numberand street, city, state, ZIP
Does applicant own property in any other ( If yes, what county?
county in Indiana?
Deduction approved in�the amount of:
20 �_ 20 �_ 20 �
P P P
Signature
What Taxii
COUNTY AUDITOR
20
County Auditor
20
property in question:
al Property ❑ Mobile Home
Dra�ver NO��Lo." �� �o�
CaC(� ��� . .....................
20
�
fr1.7
1 on
� No
We certify under the penalty of perjury that the above and toregoing information is true and corred and ihat the applicants was / were
esident of Indiana and owner of the aforementioned properiy on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident address��qpn �t�` � �� �Address of authorized person
2 �� s,