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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
s ,M• ! State Form 437091R5 / 4-03) . � � �
� PresaiDed 6y Deparlment of Loral Govemment Finance
wsrRUCrioNS: MAY - 3 ZD�e Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dafes: 1) Real Property: During the 12 months before May i 1 0/ the year the deduction is toYe�je�ct��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th�yearf,�ie deduetion is to be eNective.
See reverse side for additional ins[ructions and quali�cations. GIBSON COUNTY AUDITOR
Applicant (owne� or contract 6uy - see �tdct' s on re erse side)
Taxing Distrid Key number / legal description Record number
t
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Assessed vatue oi real property as of Mortgage / ContraG indebtedness unpaid as of Is lhe applicant e sole legal or equitable
March 1, current year � March 1, current year owner? ❑ Yes ❑ No
,� � � Od7�
I( no, what is his / her exact share of interesl? It owned with someone other than spouse, indicate with whom.
If name on record is different than thaf of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC G1.1-�
�me of mortgagee or contract seller �
/
Address of mortgagee or contrad seller (number and street, city, state, ZIP .
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appiicant own property in any other If yes, what county? 4Vhat Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 0�_ 20 20 20 20 20
( I �
Signature County Auditor Date
' We certify under the penalry of perjury that ihe above and foregoing information is true and correcl and lhal lhe applicants was / were
. resident of Indiana and owner of the aforementioned properfy on March 1, 20
Spn�ture (owners lull nam� �� Person authorized by duly executed Power of Attomey
�� or by IC 6-1.1-12-.07
Full�esident address of a�plica� Address of authorized person
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