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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION
'«. ✓ Su:e Form a3709 (RS l a-03)
� PreSCnGed by Department ol Local Govemment Finance
FIL,EI�
Coun T Year
� �
GIBSON COUNTY A
INSTRUCTIONS: File Mark
To be /iled in person or by mail with the CountyAuditor of the county whe�e fhe property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 0( the year fhe deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is to be e((ecfive.
See reverse side /or additional instructions and qualifications.
Applicant (owner or conf�act buyer • see
Taxing Distrid
� �.*-flciC �L.
Assessed value of real property as oi
March 1, wrrent year
If no, whai is his / her exact share
side)
number / legal description
D�S'-a/400 �d
MoAgage / Contracl indebtedness unp.
March 1, current year
If name on record is different than lhat of applicanf,
mortgagee or contract seller
Address of mortgagee or conirad seller (number
Name of assignee or
Address
Does applicant own p
wunty in Indiana?
Deduction approved
20 � •
Signature ��,
0
IRecord number � �
Page number � C � �
J
as of Is the applicant the sole legal or
owner? ❑ Yes ❑ No
I( owned with someone other than spouse, indicate with whom.
Is the property in questian:
❑ Real Property ❑ Mobile Home (IC 61.1
city, state, ZIP
� Drawer �'O 6`�"'. °��1.. o
� k
Car
d �'O. .... �--
•• ..., Nhat Taxing District? Has this deduction been requested on
•• property for currentyear?� Yes� No
in the amount of:
20 � 20 �_
�° �,P
COUNTY AUDITOR
20 20
�P
County Auditor
20
Date
20
' We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
name) .
of
Person authorized by duly executed Power ot Attorney
or by IC 6-7.1-12-.07 �
of authorized person