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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
°. �� / State Fortr; 63709 (R5 / 4-03) .
� Presai6ee oy Department of Lcv'�I Govemment Finance
INSTRUCTIONS: � � � �Fi M
To be filed in person or by mail with the CounryAuditor of the county whe�e the property is 1 ate
Filing Dafes: 1) Real Property: During the 12 months be)ore May 71 0! the year the deduction is to be eliective.
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ th�� tf�e �Ie�'�Fyn is to be'eflective.
See reverse side for addifional instnictions and qualifications.
(owner or contract
Taxing Dislrid
Assessed value of real property as of
March 1, current year
�io, what is his / her exact share of interest?
Key
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MoRgage / Contract ir
March 1, current year
If name on record is different than that of applirant, indicate beiow:
�me of mortgagee or contracl seller
�id /.�/ /Y1
Address oF mortgagee or contract seller (number and street, city. s
Name of assignee or other owner cu holder of mortgage
n��i coau� n�...-.--
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Does a�
coun�y i �_:'-��
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Deduction appro•�ed n the amo� int nl: -- �- -... ---- -
20�'�
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SignaWre
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GIBSON COUNTY AUDITOH
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Record number O�
\ Page number � /�/
J b
as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
�0� t�gyoD I
If owned with someone other lhan spouse, indicate with whom.
s the property in question:
❑ Real Property ❑ Mobile Horne pC 61.1
y? I �Vhat Taxing Distrid? Has this dedudion been requested on
property for current year? � Yes 0 No
�OUNTY AUDITOR
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__ ___ _ __ County Auditor
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20
Date
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Wr. r£Kifij under �ne ;,•:,aliy of per;��r� �h,i thP ahove and foreaoina informaY�n is }ru� and corred and thal lhe applicants was / were
'esirir.nt of Indiana ar•d owner of thP aforementioned property on March L 20
'ld�nt ari�tresc of ag�
S�5 3��?,�N
Person a��thorizeri by duly executed Power of Httomey
or hy IG 6-1.1-12-.07
aCcTOnI � �AdAress of authorized person