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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
s ,M. -J SlareFwm437W (RS/4-03) ��� � �
� PresuiDed Gy Department of Local Govemment Finance
wsrRUCnorvs: MAY �;i�f�Q�
To be frled in person or 6y mail with fhe County Auditor of the county where the property is located.
Filing Dafes: 1J Real Property: Dunng the 12 months 6efore May 11 of the year the deduction is to 6e e�ct�eti, ,Q
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year lhe de�uction to be effective.
See reverse side /or additional instructions and qualifications.
GIBSON COUNTY AUDITOR
Applicant (owner or contract buyer- see
1�3 � �� �
Taxing Distrid —�
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Assessed va�ue oi real property as of
March 1, current year
If no, whal is his / her exact share of
on reverse side) �
Key n�r ber / legal description Record number
- ' � ••. _ � , � / . . Page number
oa� � o �,^.
Mortgage / Contract indebtedness unpaid as of Is lhe appli�
March 1, current year owneR
_, i•_. _ �
If name on record is different lhan that of applicanl, indicate below:
of moAgagee or contract seller
s sole legal or equitabie
Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Real
� Mobile Home (IC 61.1
Address of mortga�ee or contract seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state, ZIP code) --�—f�
Dces applicant own property in any other If yes, what wunty? What D�11t � A w
county i� Indiana? � �� �� � p �
C��
approved in the amount
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�
couNrv,auon
20 �� 20 � 9_ 20
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County Auditor
o ► - (��30
20
20
quested on
� Yes❑ No
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of indiana and owner of the aforeinentioned property on March 1, 20
( �� �! �, Ph
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person
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