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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
1 J State Fortn 637W (RS I a-03) � �
w•
� Prescribed oy Depar,ment ot Local Govemment Finance
INSTRUCTIONS: File Ma
To be filed in person or by mail with the Counry Auditor of the counry where the property is located� ��+
Filing Dates: 1) Real Property: Dunng the 12 montbs before May 11 of the year the deduction is to��eRectiv�/ �j
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ tAe year the deduction is to e eNective.
See reverse side for additional instructions and qualifications. �UN � 9 Z��6
(owner
Tauing Distrid
� � ���
Assessed value of real property as of
March t, current year
If �io, what is his / her exact share of
on
Key number /
side)
GIBSON
Record number �
� / / i-�/� � 7 � � O Page number � �
v�
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, c�it year ownef? ❑ Yes ❑ No
c
aas� I
��f owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below:
� me of morigagee or contrad seller �� }.J/
�� /L
Address of moRgagee or contract seiler (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
assignee (number and street, city, s�ate. ZIP code)
Does applicant own property in any othPr ! If .�,a:_ r�hat cnunty? What Taxing District?
county in Indiana? I
COUNTY AUDITOR
Deduction approved in the amount nt:
20 � 1 � 20 �� i 20 _ oZ_ 20 _
_n _ I
— Dra���er NO..I ............... � —
Sigr _ County Auditor
�
Card NO. ��.�.�.�•l
D
20
Is the property in question:
❑ Real Property ❑ Mobile Horne (IC 61.
Has this deduction been requested on
property for wrrent year? � Yes 0 No
20
20
above and foreaoina informatton is Uue and corred and that the applicants was / were
oned property on March 1, 20 __
Person authnrized by duty execuled Power of Httomey
or by IG 6-1J-12-.07
Address of authorized person
2�% f�T ,siu„ .v