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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION '"77��- C��oun Township Year
� ,«. J Siaie Fwm 63709 (RS / 4-03) � � _ � �
PrescriDed by Department ot Local Govemment Finance
INSTRUCTIONS: �UN 2 �iteTMark
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be)ore May 11 of the year fhe deduction is to be e�e`ctive, ,�,(��.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the deductio0�s to be elfective.
GIBSON COUNTY AUDITOR
See reverse side for additional insfnictions and qualifications.
buyer
/
' ��� ,. I
Assessed value ot real property as of
March 1, cunent year
If �io, what is his / her exact share of inlerest?
side�
number/ le description
/3-/3 - �a -aa�. �08- ao7
/C� -� �08'-�
Record number
Page number
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
�OOO.ba
If owned with someone other than spouse, indicate wilh whom.
If name on record is different ihan that of applicant, indicate below:
♦me of mortgagee or contrad seiler
.��
Address of mortgagee or conlrad seller (number and ieet, city, state, ZIP
Name of assignee or olher owner nr holder of mortgage
of assignee (numberand sfreet: city, state, ZIP code)
Does applicant own property in any olhPr � If ,:�> 4••hat cnunry?
county ir Indiana? �
2�
11
Signature
4Vhat Taxing Distrid?
/ _ ��------ - —COUNTYAUDITOR Q�–
� -- / –
ro•� in 1 e amount nt:
-- I zn�g � ro_0°� 20 2� o —
--'--- P --�P---�-----I
_ ____ C.ounty Auditor
❑ Mobile Home QC 6�1.1-�
Has this deduc[ion been requested on
property for wrrent yea(?� Yes� No
r�i7
20
We rFRify under �he panalty of perjurf �h�� ihP above and foraooino informalfon is hue and corred and that ihe applicants was / were
resirieni �.la�ii�na and owner of fhe afnrementioned property on March 1: 20 __
��amr�)
f
of ao�licant Q ��� �� �
� i�,lj �'n S S"� ` C.° \it� . 1 k)
Person a��lhnrizeA by duly execuled Power of Nttomey
or by IG 6-1.1-12-.07
authonzed person