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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's N� / State Fom: a3709 (RS / 4-03) � .
�- Prescribed by Department of Local Govemment Finance -
�
INSTRUCTIONS: �J Maric
To 6e �led in person or 6y mail with the CounryAuditor of the county whe�e the property is located. APR 2 1 Z�U�
Filing Dates: 1).Real Property: During the 12 months belore May 11 of the year the deduction is to be eflective. .
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 2 of tAe y�d��n is to be eNective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
confract
Taxing Distrid
on reverse
/ legal description I Record number
,{--�,,,, D ��D//Dp�'„` Pagenumber
(/!/Y' (O �/ �.Ci
Assessed value of real property as of Mortgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
5
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
name on record is different lhan that of applicant, indicate below:
�me of mortgagee or conlract seller �
Address of mortgagee or contrad seller
Name of assignee or other owner or
st2et, city, state, ZIP
mortgage
Address of assignee (number and streef, city, state, ZIP code)
Dces applicant own property in any other I If yes, what county? I What Taxing Districl?
county in Indiana?
Deduction approved in the amounl of:
20 � � zo _b�
Q (
Signature
COUNTY AUDITOR
20 09 zo 20
P
County Auditor
s the property in question:
❑ Real Property ❑ Mobile Home QC 6-1.
oc�- 9��
Has this dedudion been requested on
property for curcent yeaR � Yes ❑ No
20
Date
20 ,
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esid�nt of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty
or by IC 6-1.1-12-.07
of authorized person
Attamey