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a.� "•�A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co Township Year
e�1 FOR DEDUCTION FROM ASSESSED VALUATION
�'�� �� Sute Form 43709 (RN / 6-09) Gi � n Joh 01
e �
- Prescnbed by Department of Local Govemment Fi�nce
INSTRUCTIONS: FilO Mark
nr
To be filed in person or by mail. �;6or n w
Filing Dafes: 7) Real Pmperty: Must be mmpleled and dated in fhe calendar year lor which the deduction is soughL � �unry Auditor
Musf be filed with the County Auditor or County RecoNer oJ the county whe2 fhe pmperty is Ixate
on or belore January 5 o/(he immediately succeeding calendar yeac s. rder
2� Mobile /Manu/acfumd Homes nof assessed as Real Properry: Must file with fhe CounryAudifoi o( L6aIbS0
covnfy where the property is /ocated dunng fhe M1veNe (72) months be/ore March 31 0/ each year the
deducfion is sought.
See reverse side /or addifional instruc6ons and quali�cations.
Applicant (owner w wn✓sct buyer - sea resnictions on reverse side)
Scott W Howard and Cassandra Howard
Ta+�ing District Key numbeN legal descnpcion Record number
Johnson Township 26-18-36-300-002.376-024 Lot 220 Hunier's Crossing Sub Sec 2 ��(� ��
Assessed va:ue of real property as of Mortgage / ConVaG indebtedness unpaid az ol Mortgage I Con✓act indeblaaness unpaitl as ot Is tha applicant Ne sole
March 7, artentyear Mar h 1. nirrent year date of applifation legal or equitade ovmeR
5175,400 5)�0, S7J'� � Yes ❑ No
If no, what is his / her exact share oi interest?
If name on recor0 ¢ difterent than tha[ ol apPfimnt, indinte below:
Name of mortgagee or mnVaU
Old National Bank
Adtlress of mortgagee or con(rect seller (numberand streef, ciry, state, and ZIP code)
1 Main Street, Evansvil�e, IN 47708
Name of assignee or oUer owner or holder ol rtrortgaga
Address of assgnee (number and sveet, ciry, sW.e, and ZIP code)
ownetl with someone
licant awn pmperty in any oNer I If yes, what countyl I What Taxing District7
Indana?
n Yes ,� No
spouse,
Is the pmperty in question: MnualyPSSesseO
�❑ Real Property ❑ MnuallyAssessed
Has Nis Eeduction been
for wrrent Y�r?
stetl an properry
Yes ❑
COUNTY AUDITOR
Deduclion appmved in lhe amounl of:
20 _ 20 20 20 _ 20 20 _ 20
Sgnature of CounryAuditor Counry Da[e (month, day, year)
I/ We certify under the penalry of perjury ihal lhe above and foregoing infortnation is Irue and cortect and that the applicant is a resident of Intliana and
owner I contract buyer oi the aforementioned pmperty on date applipBOn is filed.
Signature /WI nam Date (monfh, day, yna�
11 "r1`i2010
Fu siden address of appii nt (number and street, tiry, state, aM ZIP cade)
1412 W. Chukar Hollow, Haubstadt, IN 47639 �
Person auNOnzeE by duly execuled Power of Attomey or by IC 67.1-12-0.7 Date (month, day, yea�
Address of au�hwizetl person (numba�and sveet, ciry, state, aM ZIP code)