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/_ai �' '� STATEMENT OF MORTGAGE OR CONTRACT IND�BTEDNESS
`i' : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
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y Sfate Fortn 43709 (R6 / SO6) ' �” �
�« Presaibetl by Department of Lotal Gwemmenl Finance
INSTRUCTIONS: SEP FLe�v1�Q07
To be filed in person or by mai/ with the County Auditor o/ the county where the p�operty is located.
Filing Dates: 1) Real P�operty: During the 12 months before ,lune Il of the year the deduction is to be elfecti6e,y�j Q�
2) Mobile Homes assessed under IC 6-1.7-7: Between January 75 and March 2 o/the year the d'edu�n is to e//B tive.
See �everse side lor additional instructions and qualifications. G18SON COUNTY AW�T�7�
Applicant (owne� or contracf buyer- see iesMctions on reverse side)/� ^ ,
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Taxing Distrid Key number / legal description Record number h
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�� 0�10''��v��✓ ���• lS / Q�6 Pagenumber � �
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes � No
V ��
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of moAgagee or contrad seller , _
Address of mortgagee or contract seller (number and st2et, city, state, 1
Name of assignee or olher owner or holder of mortgage
Address of assignee (numberand st2et..citv..state. ZIP rnrlr� __
Does applicant own property in any c Dra��'er �p •�O.Q7 " s�� ict? Has this deduction been requesled on
county in Indiana? '' �� - property for wrrent yea(? � Yes ❑ No
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Deduction approved in the amount of:
20 � 20 _ p q 20 20 20 20 20
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Signature County Audilor Date
/ We ify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
resi nl ot Indiana and owner of lhe aforemenlioned property on March t, 20
ig ture (ow rs Iull na e) � Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Ful sident a ress applipnt Address of authorized person
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