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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 437os (Ra / ta07)
PreSCribeE by Department ol Loral Govemmeni Finance
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INSTRUCTIONS: FEB �p�Ma�_2
7o be filed in person or by mail with the County Auditor o/ the county where the property is located. ���
Filing Dates: 1) Real P�operty: During fhe 12 months belo�e May 11 0l the year the deduction is to 6 e ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the ear the ed cti 's to 6 ff ive.
See reverse side (or additional instiuctions and quali�cations. GIBSON COU�, : y�,�pi70R
(ownerolcontracf buye; -
/1 i
value of real property as of
March 1, current year
If no, what is his / her exact share of
reverse
Key nur�Qr / legal description � Record number
�0 �l'C� �r/� -� .�
Page number
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
If owned with someone olher than spouse, indicate with whom.
If name on record is differeni ihan that of applicant, indicate below:
mortgagee or contract seiler
Address of mortgagee or contraIX seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other I If yes, what county? What Taxing Distrid?
counfy in Indiana?
20
approved in the amount of:
20 �_
COUNTY AUDITOR
20 20 � 20
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County Auditor
s the property in question:
❑ Real Property p Mobile Home QC G1.1-�
Has this dedudion been requested on
property for current year? � Yes ❑ No
20
Date
20 l� �
r
fy under the penalty of perjury that the above and foregoing information is lrue and correct and ihat the applicants was / were
of Indiana and owner of the aforemenlioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person