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;ai ,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\i'�i: FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
- `'�,=+ State Fwm 43709 (R6 / SO6) � . . .
� �n.
Presaibetl by Department of Lotal Gavemmen� Finance
iNSrRUCnoNS: NUV 1 5 261�1Ma"`
To be filed in person or by mail with the County Auditor of the county whe�e.the property is located.
Filing Dates: 1) Real Property: Dunng the 72 monlhs befo2 ,lune 17 0/ fhe year the deduction is to b Nective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the y5�� is to be elfective.
See reverse side /or additional instructions and qualifications. GIBSON COUNTY UDITOR
Applicant
Taxing
buyer-see
Assessed value of real property as of
March i, current year
Key number / legal description U Record num
Page numb�
!b- y- s-loo-ao�. i8-Oao �
Mortgage / ContreG indebtedness unpaid as of Is the a
March 1, curtent year owneR
4 l� -� /h111:.
If no, what is his / her exact share of interest7
name on record is different than that of
indicate below:
t me soie iegai or
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
�me of mortgagee or contrad sell�er .�yy.� �.�-��
M.�.Cp/� (.>'�C�K.CB �
Address of moAgagee or contract seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage
assignee (numberand street, city,
Does applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved in fhe amount of:
20 �_ 20 � 20
P P
Signature
Is the property in question:
❑ Real PropeAy ❑ Mobite Hane OC 61.
What Taxing Distrid? Has this dedudion been requesied on
property for wrrent yean 0 Yes ❑ No
COUNTY AUDITOR
�
County Auditor
20
20
Date
20
' We certify under the penalty of peryury thal the above and foregoing informalion is true and correcl and that the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Signature
Person authorized b�
or by IC 6-1.1-12-.07
Full resident address of applicant IAddress of authorized person