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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
�• w/ State Form e3709 (R5/ a-03)
� P2scnDed by Department ot local G6vemment Finance
INSTRUCTIONS:
Coun Township Year
File ark
To be filed in person or by mail wi[h the County Auditor of the county whe�e the property is located. MAY 9 2���
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be eRective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maroh 2 of tbe yea�,J� ded��is to 6e etfective.
See reverse side lor additional instructions and qualifrcations.
O'��
GIBSON COUNTY AUDITOR
Taxing
Key number / legal description
number �
� %1 !� (/ /1 �•p j71� Page number �j/
�f lJ T—CJ [� 0
value o( real properly as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole �egal or
wrrent year March 1, currerit1year owner? ❑ Yes ❑ No
If no, what is his / her exact snare
name on record is different than that of applicant, indicate
of mortgagee or contract seller
Address of mortgagee or contract seller (number and
Name of assignee or other owner or hoider of mortgage
Address of assignee (num6er and st2et, city, state, ZIP
Does applicant own property in any other I If yes, what county?
counry in Indiana?
appr
20
Signature
state, ZIP
Drawer NO. D..!..- ��/�
Card NO . .....................
Couniy Auditor
� I
with someone other than spouse, indicate with whom.
What Taxing District?
AUDITOR
20
s the property in question:
❑ Real PropeAy ❑ Mobile Home pC 6-1.
Has this deduction been requested on
property for current year?�] Yes❑ No
�
Date
20
We certify under the penalty of perjury lhat the above and toregoing information is true and correct and ihat the applicants was / were
resident of Indiana and owner of the atoremeniioned property on March 1, 20
lull name)
Person auihorized by duly execuled Power of Attorney
or by IC 6-7.1-12-.07
Full 7estident address of �plicant n, � �Address of authorized person