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i i�" f� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i•�, FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
N� ! Stala Fam 43709 (R6 / S-06)
� Presaibed by �epartment of Local Gwemment Finance
INSTRUCTIONS: OCT IF�LUU/
To be filed in person or 6y mail wdh the County Auditor of the county where the p�operty is localed.
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune Il of the year the deduction is to 6e efleFt{ve. "���
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year lh�%��sstien�� be effective.
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See reverse side /or additional instructions and qualifrcations. GIBSON COUNTY AUDITOR
6uyer-
i auing u�5tnc! //' Key number / legal description cord number
' / v �/01�oo3�ce3.%i9.
^ � /�Q O� n age number
LC�iJ �C /
Assessed vatue of real property s of Mortgage ! Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, aurent year March 1, airtent year owner? ❑ Yes ❑ No '
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is d'rfferent than that ot applicant, indicate below:
�me of mortgagee or conVact seller
!
Address o( rtqrtgagee or contrad selier (number and street, a, s�
Name of asalgnee or
Address ot
owner or
st2et,
Does applicaM own property in any
county in Indiana?
r of mortgage
aty; state, ZIP code)
I/yes, what county?
Deduction app�oved in the amouni of:
20 _0,�1, 20 20
P
Signature
��� We certify under the penalty oi pe
esident o ndiana and owner of
� S� r o ers (u!I na �
i
IFu resident address o plicant
� 33D� s l� h�i'
s the property in questian:
❑ Real Property ❑ Mobile Horne pC 61.1-�
.
6y.°°
� �.�.......
Whatl DYa�Ver�O••"'� � te❑No
Cat d \O
COUNTY AUDITOR
20
County Auditor
20
20
20
that the above and foregoing information is true and corred and that the applicanls was ! were
rremenlioned property on March 1, 20
/
Person authorized by duly executed Power ot Attomey
or by IC 6-1.1-12-.07
4ddress ofauthorized person