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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �«• J State Fwrt•.437W (R5 / a-03) . � � �
PresaiDed by Departmem of Loral Govemment Finance
INSTRUCTIONS: MAY F�i�a(�16
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1 J Real Property: During fhe 12 monlhs be%re May 11 of the year the deduction is to be efJect� �Q��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the ded�ion is o 6e ef/ective.
GIBSON COUNTY AUDITOR
See reverse side for additional instnictions and qualifications.
Applicant (owner o'r contract buyer - see
�
Tauing Distrid
I�{Y ��`''�,���
Assessed value of real property' yslof
March 1, current year
If no, what is his / her exact share of interesl?
reverse side)
Key number / legal description � Record number
606 -Q' I /� �,,�'y1 � '- Page number ��
�r w
Mortgage / Conlract indebtedness unpaid as of Is the.applicant the sole legal or equitable
March 1, wrrent year " owner? ❑ Yes ❑ No
� 5:,: ..
If owned with someone olher than spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below:
'me of mortgagee or contraIX seiler
Address of mortgagee or contrad seller (number and street, city, sl
— � 'GlU/- . /7
Is the property in questia
ZIP
❑ Real Properry ❑ Mobile Hmie (IC 61.1-�
Name of assignee or other owner or h�
Dra�ti�er NO��........
Address of assignee (number and stre
Card NO. p......C...°.?� .......
Dces appliwnt own property in any ott S�� `R �°�Ji� � Has this dedudion been requested on
county in indiana? property for current yeaR � Yes ❑ No
Deduction approved in the amount of:
.+��
Signature
20 DY
COUNTY AUDITOR
20 0�_ 20 20
P
County Auditor
C��
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 ihe aforementioned property on March 1, 20
Person authorized by duty executed Power of Afforney
or by IC 6-1.1-12-.07
authorized person