HomeMy WebLinkAboutMortgage_Campbello� "'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
i�� FOR DEDUCTION FROM ASSESSED VALUATION
S�� SlateFOrme3709(R11/6-09) .
Prescn0etl by Department o� Local Government Finance
li
INSTRUCTIONS:
To 6e filed in person or by mail. MAY ���e�'Q�
Filing Dates: 7) Real Property: Must 6e compfeted and datetl in Ihe calendai year tor which (he deduction is sought.
Must 6e filed witA the CountyAudifor or Counry Recorder olthe counry where the property is located ❑ County Audi;or
on or belore January 5 0l (he immedia(ely succeeding calendar yeac `'�y�> �. ounry Recorder
2) Mobile /Manu/actured Homes nof assessed as Real PropeAy: Musf file wifh fhe CountyAudilor o7fhe0'�
counry where fhe pmperty is located dunng the twelve (72) months befo�e March 31 of each ye he
deducfion is sought. C��Ei6N P.611NfiY l� . B�'i��f
See reverse side !or additlonal insfruc(ions and qualifications.
Appticant (owner w crnvaa buyer - see resbiclions m reverse sitle)
Chrisiine J. Campbell
Taung Di5iricl Key numDer / legal 4e5criDlion Record number Page num6er
Fi Branch 26-79-18-701-001.151-026 / Lot 8 Little York Village Phase II
4ssesseC value of real p(opeM1y as of Mortgage / CanVad ifMebletlness unpaid as ol Morlgage / Contrad in0ebtedne55 unpaiC as ot Is Ne applifant the sde
vch 1, arten� year Mamh 1, wrtent year Eate of appliption legal w epuilaWe owner7
a191,800.00 $140,000.00 5163,250.00 ❑� Yes ❑ No
II no, what is Ns / her eyact share ol in:eresi? If owneE wiN someone o�her �han spousa, indicate vrith whom
If name on recorC is tliflereN Ihan Ihat of apDlitani, intlicate Delow[ Is the property in Quesfion: MnuallyhssesseC
❑� Real Property ❑ MnuallyASSessed
Mobile Hane QC 61.1-7)
Name ot moM1ga9ee a contract seller
Heritage Federal Credit Union
Address af rtrortgagee w mnVaci seller (number arM s'veet, ury. sfate, and ZlPCOtle)
5388 Old State Road 66, Newburgh, IN 47630
Name of assignee or other owner or holder of mortgage
Address of assignee (number and svee4 dry, sro:e. and Z/P code)
Does applicant mm pmperty in any oNer II yes, what wunry? What Taxing Disvict7 Has this tleCUCtion bcen requested on property
counry in Indiana? for wnenl yeaR
❑ Yes ❑� No ❑ Yes ❑ No
20
COUNN AUDITOR
wnt o/:
20 20 20 20
Counry
20
Date (rtanN, day, yea�
20
I/ We certify under lhe penalty of perjury that the above and foregoing inlormation is We and cortect and tha� the applicant is a resident of Indiana and
owner I conVact buyer of the aforemen:ioned property on date application is filed.
Fu0 resLEfi� zCdwss of applicant (num0er anp sneet. city, stare,
909 Blackfoot Drive, FL Branch, IN 47648
by IC 67.142-07
person (number and svcel. crty, sfafe. antl ZIP crode)
04/2312010
Date (monN, Eay, yea�