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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
: ! SUte Porm a3709 (RS I 4-03) • .. • •. ; i ; . � ,
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PreSCnDed by DepaRment ot Local Govemment Finance �
INSTRUCTIONS: �.'�.',-� i t :, .-� ' � , +' 7 -. �dl�b a� . _ .
To be filed in person or by mail with the County Auditor of the county where the property is located. FEB 1 �
Filing Dates: 1) Real Pzperty:;During the 12:months 6efore.May fYof the year the deduction is to be e/%ctive: •
; 2J,Mobile; Homes,assessed under.IC 6 1.1-7, Between January 15 and March 2 of the y�a��tqe d !on is to be e/(ective.
. _, : . . . .��.... . .
See reverse side /or additional instructions and qualifrcations. GIBSON CO NU TY AUDITOR' '
(owner
see
Tauing Dislrid ' ' o
` V IC�'l
Assessed value ofrealproperty as of
March 1, curtent year
If no, what is his / her exact share of interest?
;ey number / legal
l.J ` � � l.
Mortgage / Contrad ii
March 1, current year
5�,1
If name on record is different lhan that of applicanl, indicate
of mortgagee or contract seller
Record
F� ' '
���
:..
unpaid as of Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (num6erand st2et,
Does applicant own propeAy in any
counfy in Indiana?
Deduction approved in the amount of:
20 _ [Z 7 � 20
P � �
Signature
state, ZIP code)
If yes, what county? I What Taxing District?
COUNTY AUDITOR
20 rl 'I 20 20
-��- f-
�
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Horne pC 6�1.1-�
Has this dedudion been requested on
property for current yea(� � Yes � No
20
Date
20
ceAify under the penaity of perjury that the above and foregoing information is true and corred and ihat the applicants was / were
I�ht of Indiana and owner of the aforementioned property on March 1, 20
(owners full
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
address of applicant �Address of authorized person