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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
: M� / Slate Form d3709 (RS l 4-03) - '
� Prescnbed by Department oF Local Guvemment Finance
INSTRUCTIONS: � �
To tie filed in person or by mail with the County Auditor of the county whe�e fhe property is located. ���p7 4 2��6
Filing Dates: 1) Real PropeRy: Dunng the 12 montbs before May 11 01 the year the deduction is to 6e'L�ctMe.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be eHective.
See reverse side for addifional instructions and qualificatio� � �a� ,Gf�
� �11 � �'��-
, r GIBSON COUNTY AUDITOR
Applicant (ownerorcortf►d�f`yuyer-
7axing
Key number / legal
Assessed vatue of real property as of Mortgage % Contred
March 1, current year March 1, wrrent yee
l�
If no, what is his / her exact share of interest?
If name on record is different lhan that of applicant, indicate below:
mortgagee or contract seller
Address of mortgagee or conlrad seller
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eet, �city, state, ZIP
Record number � �
/n � I Page number
—'lJ
as of Is lhe appticant the sole legal or
ownef? ❑ Yes � No
�00 �
owned with someone other than spouse, indicate with whom.
city, state, Z!P
Is the property in question:
O Reat Property ❑ Mobile Hortie QC 61.1-�
Does applicant own properfy in any other If yes, what county? � What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year?� YesO No
Deduction approved in the amount of:
20 _Q_ 20 �� 20 O q
P � �
Signature
COUNTY AUDITOR
20
County Auditor
20
�
Date
20
We certify under the penalty of perjury that the above and foregoing infortnation is irue and correct and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
(owners /ull namej
' ��,��., 9.,�`f,�
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person