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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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� I Prescnbetl by Depanment o( Lacal Govemment Finance
INSTRUCTIONS � MAR 1 �;�f}Q�,�
To be filed in person or 6y mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months 6e%ie May 11 0/ the year the deduction is to be effee��ive. ��
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea�he°de�ucNo�'js to be effective.
See reverse side for additional instructions and qualiTcations. GIBSON COUNTY AUDITOR
see restrictions
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Taxing Dislrict Key number / legai description Record number
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Q. (/Q Page number
Assessed vatue of real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, current year owner? ❑ Yes ❑ No
Ii no, whal is his / her exac[ share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is differenl than that of appliwnt, indicate below: Is the property in question:
of mortgagee or contrad seller
Address of mortgagee or contrad selier number �/iAst2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? Wha
wunty in Indiana?
couNn auo
Deduction approved in the amount of:
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Signature
Full
County Auditor
Real Property ❑ Mobile Home (IC 61.
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a�o 7- i7 a'�
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certify under the penalty of perjury that the above and foregoing information is true and wrred and that the applicants was / were
lent of Indiana and owner of the atorementioned property on March 1, 20
0
name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person