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��o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T n'ip •�Ye
ia _,_ 4 FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn d3709 (R11 / 6-09)
�� � PrescnbeE by Depanmem of Local Govemment Finance
Fil
INSTRUCT/ONS:
To be filed in person or by mail. Forr�a�.'
Filing Dates: 7� Real Property: Musf 6e completed and datetl in ihe calendar year /or which the deduc(ion is sought. ❑
Must be Iiled wifh the CountyAuditor or County Recorder ol fhe county where the property is located Coun
on or belore January 5 oI the immediafely Succeeding calendar year. �� L.�p� �QR
2) Mobile / Manufacrored Homes not assessed as Real Property: Must file wi(h fhe County Auditor o/ the
counry where the pmperty is located dunng the nvelve (72) monfhs before March 37 0/ each year the
deduction is sought.
See reverse side 7or addifional instruclions and qualifications.
AppGwnt (avrrer w connaa Duyer- see resfictrons m reverse side)
Thomas E. Arendell, Jr. and Trisha Jolene Arendell .
Tadng Disvia Key number / legal desuipUon Record number Page number --
26-14-18304-000-074-007 �a' -�(�( Instruaen
Assessed vWue W real pmpeM1y as oi Mortgage / CanVaq irMeOtedness unpaid as W Mortgage I Convaq indebtedness unpaid as af Is �he appl" 4
� 1, wrtentyear March 1. arrent year �� _ date af appGwtron legal or equitade owneR
; a"'—' _
544,800.00 ❑� Yes ❑ No
If no, what is his / �er exact share of interest? If ovmetl with someone other itun spouse. indicate with xTOm
It name on recorC is Eitterent Ihan ihai ot appGcant, inCicate Oebw: Is the property in question: MnuaDyASSessed
�❑ Reat Pmperry ❑ MnuallyASSessed
Mobile Home (IC Cr1.1-7)
Nama ol mortgagea w mntrac� se0er
Heritage Federal Credit Union
Adtlress of mortgagee w con4ad seDer (number and sLeef, crry, stale, anC ZIP code)
5388 OId State Road 66, Newburgh, IN 47630
Name of assignee or oNer owner or hdder of mongage
Atltlress o( assignee (numbar and streef. ciry, state, antl ZlPcotle)
Does apPliwnt own property in any oNet If yes, what munq? What Taxing DisViU? Has Nis deduction baen requesteE an pmperty
coun in Indara? for curtent eaR
N v
❑ Yes ❑� No ❑ Yes ❑ No
COUNTY AUDITOR
DeduNOn approveE in Ne artauni of:
20 _ 20 20 _ 20 _ 20 _ 20 20
Synature ol Counry Auditor County Date (rtwnM, day, yea^
I/ We certify under the penalry of perjury that the above and foregoing information is We and correci and thai the applicant is a resitlent of Indiana and
owner I wnVaIX buyer of the aforementio ed roperty on date application is filed.
�Signatur eYstNlna e) , ate (mmN, tlay, yeen
r l
Fu0 resident aCEress ol appliwnt (number nd ef, uty, slafe, a(M ZIP cotle)
223 W. Morton St., Oakland City, In 7660
Person auNOrizeE Cy duly e.ecutetl Pmxer ot Attwney or Gy IC 61.142-07 Date (monfh, day. yee�
Address of author¢eE person (number arM s:raet ciry, sfafe, aM ZIP code)