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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
��«• i State Form a3709 (RS I 4-03) � ...
Presaibetl Ey Department ol Loral Govemment Finance
INSTRUCTIONS: a�
To be filed in person or by mail with the County Auditor ol the county where the property is located. MAY S����
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year tne deduction is to 6e effective.
2) Mo6ile Homes assessed under IC 6-1 J-7: Between January 15 and March 2 0/ the yea,r.the deduCt� is to be effective.
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See reverse side for additional instructions and quali�cations. U
GIBSON COUNTY AUDITOR
Appiicant (owneror
1.
- see resm �ons op reverye 9yue�
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Key number / legal description
Record number
/� _n ��/'�`lA� Page number
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Assessed value of real property as of Mortgage / ContreU indebledness unpaid as of Is the applicani the sole legal or equitable
March 1, current year March 1, current yea owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
of mortgagee or contraIX seller
Address of mortgagee or contrad seller (number and street; city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (numbe� and sfieet, city, state, ZIP code)
Does applicant own property in any other I If yes, what county? What Taxing District?
county in Indiana?
Deductiomapproved in the amouN of:
2G h 1
P
Signature _
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A
,
COUNTY AUDITOR
20 0 9 20 20
f
County Auditor
❑ Real Property ❑ Mobile Home QC Cr1.1-�
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Has this deduclion been requested on
property for current year? �] Yes ❑ No
20
Date
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Signature
i
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Person aulhorized by duly
or by IC 6-1.1-12-.07
of authorized person
Attorney