HomeMy WebLinkAboutMortgage_McCulloughdF�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
e.._ s FOR DEDUCTION FROM ASSESSED VALUATION
S�'� � Sia;e Fwm e3709 (R71 / 6-09) .
��+ PrescnCetl by Depatlment d Local Govemment Financa
Count Township Year y
File Mark
INSTRUCTIONS:
To be filed in person or by mail. FE tJe
Filinq Oates: 7) Real Propeny: Musf be comple(ed and dafed in Ihe wlendar year tor which the deductlon is soughf. unt Audiror
Must be filed with the Counry Auditor or County Recorder ol the counry where fhe property is locafed C, ,�Y
on or before January 5 0l fhe immediafely succeeding calendar year. ty Rewrder
2J Mobile /Manu(ac7ured Homes not assessed as Real Property: Mus1 file with the CounryAudilor of the
counry where the property is located dunng the nvelve (12) monl6s be7ore March 37 o/each ye�r�ON C
deduction is sought.
See ieverse side !or adtli(ional insWCrions and qualifica(ions.
Applicant (owne� a wnvad buyer - see msvic+ims on reverse sitle)
Dwayne Eric McCullough '
Taung Disina Key numbeN legal tlescriplbn ReeorE number Page numEer
Haubstadt 26-1836404-000.227-009 Lot 104 East Side South Weber Drive ap\� ��
Assessed value of real pmpeM1y as ol Mortgage / Contran indebtedness unpaitl as ol Mortgage I ConVaa intlebtedness unpaid as of Is �he aOWiwnt Ne wle
A7arN 1, artent year March t, wrrent year date of applicaGOn legal or equilaGe owner?
�594,690.00 595,000.00 5111.200.00 � Yes ❑ No
It no, what is ttis / her eMact share of in:erest? If owned with someone oNer Nan spouse. iMicate wi�h whom
If name on record is diflerent Nan Nat of applicant, intlicate Oelow: Is the propetty in quesGOn: AnnuallyAUe55ed
� ❑� Real Property ❑ MnualyASSessetl
Mobile Home QC 6-1.1-7)
Name o! moM1gagee or mntract seller
Heritage Federal Credit Union
Atltlress af rtrortgagee or mnUact seiler (numbe� and street, ciry, sare, arM ZIP code)
5388 Old State Road 66, Newburgh, IN 47630
Name of assignee or olher owner or hoider of mortgage
Adtlress at assignee (number and slreeL city, sta;e. and ZIP code)
Does aOW��nt ovm pmperty in any o;her If yes, what counry? What Taxing District? Has Utis CeGUCtion been reques;ed m pmperty
counry in Indiana? for wrtent yeaR
❑ Yes ❑O No ❑ Yes ❑ No
COUNN AUDITOR
Detluction approved in Ihe artwun� ot
20 20 20 _ 20 20 _ 20 20 _
Signamre of Counry Audi;o - Counry Daie (month, day, year)
C
I I We certiry under Ihe pen y o( perj� t the above and foregoing informaGon is tme and wrtect and lhat the applicant is a resident of Indiana and
owner / wntract buyer of lhe aforeme ''o tl property on date applicalion is filed.
Signat owne/s 7W name) � �ate (rtanN, tlay, yea�
01I28/2011
rull resident addre of applicant (numb r aM et ciry, stare, and code)
704 S. Weber Drive. Haubstadi, IN 47639
Person autFw�ized by Guty executed Power of Anomey or by IC 61.142-07 Data (ma�1h, dag yea�
Address of authorizetl perwn (numberarntl sVeef. crty, stafe. andZlP code) �