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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form a3709 (Ra / t0-07)
Prescd0e0 Dy Department of Local Govemment Pinance
Count Township Year
INSTRUCTIONS: Pile � �
To be filed in person or 6y mail with the County Auditor o! the county whe2 the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months 6e%re May 11 0l the year the deduction is to be ch
2) Mobile Homes assessed under IC &1.7-7: Behveen January 15 and March 31 0l the �h c ion is to be el/ective.
See reverse side /or additiona! instiuctions and quafi�ca(ions. MAR 1 3 2002
Applican nerorcontract 6uyer- se� n ions on reverse side)
� � ' �� �"�1 � GIBSON COU TY AUDITOR
Taxing D' trid Key number / legal description Record number
S j/�'� / 0/ �—�g�/ �_vO Page number
i I ci
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole le al or equitable
March 1, curtent year March 1, current year owne(? ❑ Yes ❑ No
If no, whal is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than Ihat ot applicanl, indicate below: Is the property in question:
� Real Property ❑ Mobile Home (IC 61.1-�
�' ,e of mortgagee or contrad seller
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ddress of rtgagee or contrad seller (number and street, city, state, ZIP
ame of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for wrrent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
Zo �� e? Zo � zo o zo 2o h� zo zo �� l,
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Signature County Auditor Dale
���Ne certify under lhe penalty of perjury that lhe above and foregoing information is true and corred and lhal lhe applicants was / were
�ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
II resident address of ap licant Address of authorized person
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