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i i�" � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°i'. I : FOR DEDUCTION FROM ASSES8ED VALUATION
u. ! SlataFortn a3709 (R615-O6)
� Presaibed by Depenment of Local Gwemment Finance
INSTRUCTIONS:
To be filed in person o� by mail with the County Audito� of the county where the property is located. � �U� 1 3 2�0�
Filing Dates: 1) Real Property: DuAng the 12 months before June Il of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the yea educ6'on is to be effective.
See reverse side for additional instnictions and qualifrcations. a(�/, �iQ�,'
GIBSON COUN� q�pITOR
- � � .
Taxing
con6a�t buy%� - see restrictions on
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Key number / legal description
number
number
A�Sessed value of real property as of Mortgage / Contrad indebtedness unpaid as bf Is lhe applicant the sole legal or equilable
March 1, curtent year March 1, current year owneR ❑ Yes ❑ No '
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
� 3 -3-/d -���aAe- .
If name on record is different than that of applicant, indicate below: Is the property in question:
-- ❑ Real Property ❑ Mobile Home pC 61.1-n
mortgagee or contract seller
Address of mortgagee or conVact seller (number and st2et, city, state, ZIP
Name ot ecsignee or
Address
owner or holder of mortgage
(numberand street, city, state, ZIP
Does eppficant own property in any other If yes, what counry?
county in Indiana?
Dedudion
20
Signature
amounf of:
20 U �1 ( 20
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What Ta C:1 i'(� \ � . .....................•�- c- �:ed on
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COUNTY AUDITOR
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County Audilor
20
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Date
20.
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We ceAity under lhe penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20 .
��r(owners ll me) Person authorized by duly executed Power of Attomey
�� �o_ r or by IC 6-7.1-12-.07
I/ A� �
ni reswem aaaress or appucant Address of authorized person
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