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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
'a � �/ Stata Fortn 437 W(RS / 4-03)
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� Presai�ed by Depanment of Local Govemment Finance
INSTRUCTIONS: OCT ���` ��f�3
To be filed in person or by mail with the Counry Auditor of the county where the property is located.
Filing Dafes: 1) Real Property: During the 12 months before May 11 01 the year fhe deduction is to b effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ar the ded cti s to b effe ive.
See reverse side !or additional instructions and quali�cations. GIBSON COU TY AUDITOR
Applicant (owneror prt�t buyer- see
Taxing Distrid //
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Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
on reverse
Key number / legal description
�o�_o�oS��-oa
Mortgage / Contrad indebtedness unpaid as o
March 1, current year /,��Cd(Ja
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If name on rewrd is diHerent than that of applicanl, indicate below:
mortgagee or contract seller
�V �/ /
Record number
Page number �
f Is the applicant the �e legal or equitable
owne(? ❑ Yes ❑ No
If owned with someone olher than spouse, indicate with whom.
Address of mortgagee or contraIX seller (number and street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
(numberand street, city, state, ZIP code)
Does applicant own property in any other I If yes, what rn���*•^
county in Indiana? �
Is the property in question:
❑ Real Properly ❑ Mobile Home QC 61.
� -
U property for cunent year? � Yes ❑ No
� 20
� �
County Auditor
DY 20�_ 20
/ `
Date
We cerfity under the penalty of perjury that the above and foregoing informalion is true and corred and thal lhe applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
(owners /ull name)
applipC�t
� r�
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
of authorized person