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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
♦ State Fortn 437W (RS / 4-03) -
� PfascriDed by Depertment ot Lxal Govemment Finance
Coun Township Year
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INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the Counry Auditor of the county where the property is located. A� � � 3 2��6
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 oI the year the deduction is to be eNective. .
2) Mobile Homes assessed under IC 6-1.1J: Behveen January 15 and March 2 0/ the year the deduction is to 6e effective.
See reverse side for additional inshuctions and qual�cations. ✓��U '�`�'
GIBSON COUNTY AUDITOR
(owne� or contiact
Taxing
Assessed value ofrealproperty as of
March 1, current year �
Key nudiber / legal des p c
ijG /�%03�—�110—
d03 -�
MoAgage / ContreG indebtec
March 1, curzenl year
53ooa
. 78/-a�G
� �'�l�l
:ss unpaid as o1
��j G�u e
Record
Page
Is the applicant lhe sole legal or
owne(? ❑ Yes ❑ No
If �io, what is his / her exad share of interesl? If owned wilh someone other than spouse, indicate with whom.
. 07-3�3(,
If name on record is different ihan that of applicant, indicate betow: Is the pro e �n qque�stios�( :
❑ Real �p�rty I "❑'Fho�ile Home p(
�me of moAgagee or contract seiler
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
(num6er and st2et, city, state, ZIP code) �
Does applicant own property.in �—�� ���
county in Indiana� —' r f C
C°�N/T�I �Gj�� �f�SP
Deduction approve �/ "
20 �u _Q$ 20 _� 20
Q P P
Signature
County Auditor
What Taxing District?
DITOR
20
Has this dedudion been requested on
property for current year? � Yes � No
20
Date
i��]
certify under the penalry of peryury that the above and foregoing information is true and corted and lhat ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
resident address of applicant U � IAddress of authorized person