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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �� J State Fwm <3709 (RS / 4-03) �T .�
� Presaibe0 by Depanment of Lqcal ,ovemment Finance �
wsrRUCnoNS: ��� 1 4 Zpg6e Mark
To be filed in person or by mail wfth the County Auditor of the county wAere the property is located.
Filing Dates: 1) Real Property: During the 12 monfhs before May 11 oI the year the deduction is to.ber�eBective.`
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI the;yeaithe�'edGction is to be effective.
See reverse side for additional instructions and qualifrcations. GIBSON COUNTY AUDITOR �
Applicant
Taxing
-see s
��� �
Assessed value of real properiy as of
March 1, cunent year
If �io, what is his / her exact share of interest?
Key number / I al descriptio Record number
�1G-�/-i�//o%c01's��-oa7 OS
O � (J — � / sa / � Page number �� � O
Mortgage / Contrad indebtedness unpaid as of Is the applicant lhe sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
If name on record is diHerent than that of applicant,
of mortgagee or contrad seiler
Address of mortgagee or contrect selier (number
Name of assignee or other owner or holder of mortgage
assignee (number and street, city, stafe, Z!P
below:
city.
If owned with someone other lhan spouse, indicate with whom.
Does applicant ow� property in any olh�r � If ��.�;, what county? What 7axing District?
county ir Indiana? �
COUNTY AUDITOR
approved in the amount of:
Dra�ver N0:.�4!��,7::....
Card NO 7.°��.......
o�- �n4#.�¢ 5�
ieniuem u� mmenn anu uwnei o� me a��o��en
mature IowneCs fni� r•am�t I_ /. /
20
:ounty Auditor
20
Is the property in question:
❑ Real Property ❑ Mobile Home QC Cr1.1-
Has lhis dedudion been requested on
property for wrtent year? 0 YesO No
20
Date
�
above and fomooina informatlon is true and corred and that ihe applicants was / were
med propeRy on March 1, 20
Person authorized by duly exewted Power of Httomey
or by IC 6-7.1-12-.07
�nt address o/f �app�licant 'l. Addr s of authorized person
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