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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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iNSrRUCnoNS: APR �;i�i�l�l3
To 6e (led in person or by mail with the County Auditor of the county whe2 the property is located.
Filing Dates: 1) Real Praperty: During the 12 months be%re May 11 of the year the deducUon is to effective--� (/
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and Maich 31 0/ th��r'fheileducf' misto'be�eff�tive.
i GIBSOtJ COUN7Y AUDITOR )
See reverse side lor addrtional instructions and quafificaGons.
Applicant (o r r ntra buyer- se cUons on revers si e) �
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Taxing Distrid Key number / legal descriplion Record number �� �
��C_(�-� ��� ""' W�/ 3�� Page number �o��
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curtent year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
O Real Property ❑ Mobile Horne QC 61.1-�
�ame of mortgagee or contred seller
�� Drawer NO..°.?�..�.`�...:.....
Address of moRgagee or contract seller (num er and street, city, state, ZIP
Card NO. .. �Sa C�
Name of assignee or other owner or holder of mortgage """""""""'
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Address of assignee (number and sheet, city, state, ZIP code) --
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for current year?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
I/ We certify under ihe penalty of perjury that the above and foregoing infortnation is true and corred and that ihe applicants was / were
� resident of indiana and owner of the aforementioned property on March 1, 20
Signatur o r full �e) 1 j -„ Person authorized by duly executed Power ot Attomey
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Full re�j� nt addrgss of p licant Address of aulhorized person
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