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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
: M� / State Fwm 437W (R514-03) � ,
� Prescnbed by Department of Local Govemment Finance � �
Coun Townshi Year
INSTRUCTIONS: MAR �;��j�s
To be fifed in person or by mail wiih fhe County Auditor of the county where the property is located.
Fifing Dates: 1) Real Property: Dunng the 12 months belore May 11 0l the year the deduction is to 6e effective.
2J Mobile Homes assessed under IC 6-1.1J: 8etween January 15 and March 2 of the year ffi�d ucti�r '� be eNective.
See reverse side for additional instnicfions and qualifications. GIBSON COUNTY AUDITOR
(owne�
Taxing District
buyer- see restrictio/ns on reverse
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Key number / legal description
number
Oo3 -oo�r 3-� Page number �o � c
�J
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, current year March 1, currenl year owner? �Yes ❑ No
�G �0
If
no, what is his / her exact share of interest?
on record is different than that of applicanl, indicate below:
of mortgagee or wntract seller � j�
.
�s of moAgagee or contrad seller (number and street,
Name of assignee or olher owner or holder of moRgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county?
county in Indiana?
�t � �� k� i�-� - 9
Deduc6on approved in fhe amourit of:
20 fJ % 20 _� 20 �
J � 1
Signature __ ___
If owned with someone other than spouse, indicate with whom.
property in question:
al Property ❑ Mobile Home QC 61.
a • �oG �C� �3 00
ZIP
What Tr
COUNTY AUDITOR
�
County Auditor
20
Dra�ti�er t\'O...Q� � —
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Card i\'O. , —
............ i an
........ � No
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_ 20 _
Date
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We ceAify under the penalty of perjury that the above and foregoing infortnalion is true and correct and that the applicants was / were
esideni of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person
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