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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn a3709 (R6 / 5-06)
Prescnbed by Department of Loral Gwemment Finarwe
Coun Township Year
INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAuditor of the county where the property is /ocated. MAY 1 S 2���
Filing Dates: 1) Real Property: During the 12 months befoie ,lune 11 of the year the deduction is to be effective.
2J Mobile Homes assessed unde� IC 6-1.1-7: Behveen January 15 and March 2 of the year the deduc6on is lo be et(ective.
See reverse side for addrtional instruc6ons and qualifications. �� '6 �
GIBSON COUNTY AUDITOR
Applicant (owner or contract buyer - see iestricfions on reverse side)
Taxing District Key number / legal escription Record number
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Assessed value of real property as of MoRgage ! ConVact indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year owner? �fes � No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
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Ii name on record is different than that of applicant, indicate below: Is the properly in quesdon:
Properry � MoMle Fbme QC G7.1-�
N�me of moRgagee or contract seller
Address of mortg ee or contract seiler (number and sfreet, city, sfate, ZIP
Name of assignee or other owner or halder of mortgage
Address of assignee (number and stieet, city, state, ZIP code) `i ' pI�[!�J/��-+C)..L,�,
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Does applicant own property in any other If yes, what county? What Tar . ' rjQ Q 7 ested on
wunty in Indiana? C�r�] \ O. .. .`���• ••••"""' YesO No
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COUNTY AUDITOF
Deduction approved in the amount of:
20 �_ 20 �_ 20 � 20 20 20 20
F P
Signature Counly Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is We and cortect and that the applicants was / were
s�dent of Indiana and owner of the aforementioned propeRy on March 1, 20 .
...,�iatur owners f 11 name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu�e�deOnt address of app icant Address oi authorized person
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