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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEnuFCc
FOR DEDUCTION FROM ASSESSED VALUATION
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PresaiDeE by Depanment of Loral Go emment Finance 9 t
INSTRUCTIONS: E�6if�;?i i�, 9i�;
To be filed in person or by mail witA the Counry Auditor of the county where the property is located. FEB 1 � Z��6
Filing D�tes:; lh l�ea1 •Rfogerfy:�During the; j12 monUis before�May� ii1 of the year, the�eductlon is to tie. effecfive. ��U f; 2tt'_�i; F,Ii; i;qL�
t,��2JylNObile,�Homes��ssessed under,IC 6� 1, Z, Behveen January 15Nand Mauch 2 o/the�yearthsdeduc`ion,'s t ybe�effective.
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See reverse side for additional instructions and qua6�cat�ons. ,�p�f� - G'�L' IJ �JS:y6
GIBSON COUNTY AU�ITOR
(owner
Taxing
Assessed value o( real property as of
March 1, wrrent year .
on
Key number / legal description
bos-dy61
Morigage / Contred indebt
March 1, current year
I 3'l, �
If no, what is his / her exact share of interest?
If name on record is different than ihat of applicant, indicate
of mortgagee or contract seller
number
Page number
unpaid as of I Is the a�,
owneR
os.
�
t the sole legat or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address o( moRgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (num6er
Does applicant own property in any
county in Indiana?
st�eef, city, state, ZIP code)
approved in the amount of:
20 Q � 20 �
�
If yes, what county? � What Taxing Distric[?
COUNTY AUDITOR
20 �� 20 20
County Auditor
Is the praperty in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
property for current year? 0 Yes � No
20
Date
20
ceAify under the penalry of perjury that the above and foregoing information is true and correct and that the applicanls was / were
lent of Indiana and owner of the aforementioned property on March 7, 20
Person authorized by duly
or by IC 6-1.1-12-.07
of authorized person
Attomey