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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�s _ / SUte Fwm 43709 (RS I 4-03j � � �
�,, � PrescnEetl Oy Department of Local G6vemment Finance
INSTRUCTIONS: AUG 1 6 ��a�
To be filed in person or 6y mail with the County Auditor of the county where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 mon[hs befo�e May 11 0/ fhe year the deduction is to be effectivea�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the �a� fheideduction is to 6e effective.
See 2verse side for additional instructions and qual�cations. GIBSON COUNTY AUDITOR
(owner or
Disirid
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key number / legal description � Rec�yfl numb�
,7�-�� • 07- �0 3-o°�. Lo a o.+8
(� � � _.� � � � -0T Page number
�
Mortgage / Contract indebledness unpaid as of Is lhe ap�
March 1, current year �(0 6� � ownef?
(DOOOp
If name on record is diHerent ihan that of applicant, indicate below:
me of mortgagee�r contraIX seller
of mortgagee or wntrad seller (number and street,
assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appiicant own property in any other If yes, what county?
wunty in Indiana?
�
5o y 3
! the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
' I Is the
� �
ZIP
What Taxing District?
COUNTY AUDITOR
)edudion approved in the amount of:
20 20�_ 20 _� 20 20
P � .�
iignature County Auditor
❑ Real
❑ Mobile Home (IC 61.
Has this deduction been requested on
properly for current yea(�Q Yes� No
20
20
certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicants was / were
lent ot Indiana and owner of the aforementioned property on March t, 20
Signature
Full resi
7V
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person