HomeMy WebLinkAboutMortgage_Burchell (2)i. nno STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
V 1 FOR DEDUCTION FROM ASSESSED VALUATION
�• � State Form 43709 (R 71 / 6-09)
�"' � PrescnbeC by Department ot Local Govemment Finance '
INSTRUCTIONS: �a�
To6efiledinpersonorbymail. � � ���w � LUIU
Filing Dates: 7� Real Property: Must be complefed and dafed in fhe calendar year7or which fhe deduction is sought.
Must be �led wilh fhe CountyAuditor or County Recofder ol the counry wheie the property is locafed ❑ Counry Auditor
on or belore Jenuary 5 0/ fhe immediafety succeeding calendai year. - ecorder
2) Mo6ile / Manulactured Homes not assessed as Real Property: Musf �Ie wifh the County Auditor o/ the ��' �p"�
counry where fhe property is locafed dudng the Rvelve (f2) months befo2 March 31 oleach year the
deductionissought GIBSONCOUNTY AUDITOF
See reverse side for adtlitional instructions and qualificafions.
nppticant (owrrer or confraa buyer - see resnic+iw�s on reverse side)
�VICKI J BURCHELL
fabrg District Key numDer I laqal descnpUOn Record number Page number
HAUBSTADT 2E7&36-401-000.654-009 a��0 y�CS
Kcussetl rdue dreal praperty as of Mortgage / ConVact indeWedness unpaid as of Mortgage / Con•vaG indebtedness unpaid az of Is �he appliwnt ihe sde
MarN 7, wrtent year Mar� 1, curtant year date of apptifation legal or equitable ovmeR
180,000 67,800 ❑� Yes ❑ No
It no, what is his / her ezaG s�are ot interesl? If owne0 with someone oNer Nan spouse, inCicate wiN whom
If name on recortl is EiRerem Nan that of app4cant.'uMiwta bebw Is ihe pmperty in question: MnuaDy Assessed
Q Real Property ❑ Mnualty Assessed
Mobile Home QC fr7.1-7)
Name of rtwrtgagee or mnVad seiler '
UNITED FIDELITY BANK
Adtlress ot mwigagee w conVact seAer (numDer arid sbae4 c+ry. sate, aM ZIP cnde) '
18 NW FOURTH ST EVANSVIILE IN 47708
Name of assgnee or oNer owner or hdEer ol rtprtgaqe
Atltlress of as5ignee (numberand 5free; rity, sfate, antl ZIPCOEe) '
Does applicant own property in any ocher If yes, whac countyl Whal Taxing Disvia? Has this de0uctim Deen repuested on prope .ry
caun m InEiana? for wrtent ea(.�
ry ❑ Yes ❑ No Y
❑ Yes ❑ No
COUNTY AUDITOR
�eEaction aOW�'� in ihe amounl ot
20 20 20 20 20 20 20
� Signature at Counry AuEitor I Counry Date (monlh, day, year)
I I We certify u er th o erjury that the above and foregoing infortnation is We and cortect and Nat [he apDlicant is a resident of Indiana and
owne con ct buy r e afo mentioned property on d te application is filed.
Sig �tu e e/ MI rtre Date (r+wnN. tlay. year)
C 08Ii612010
Fu0 resident atltlress ol applicant num6erarM streef, city, sfafa, antl ZlPcade)
109 S CAMPBELL BIVD HAUBSTADT IN 47639
Person auNOrizeO by Guly executed Power ol Attomey or by IC 61.1-12-0J Date (month, day, year)
AdEress ot authwaetl person (number and streeq ory, stafe, and ZIP co0e)