HomeMy WebLinkAboutMortgage_Mobley (2)/; o_, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co Township Year
_"a�: FOR DEDUCTION FROM ASSESSED VALUATION '
i� ` SWteFOrtnc3709(ft11/6-09)
•�"�l Presrnbed by �epanment of Local Govemmen; Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. � D' - r Jed x� �O
Filing Dates: 7J Real Property: MusC6e complefed and dated in fhe calendar year lo� which tbe deduction is soughf.
�Ausl 6e filed with the CountyAudifo� or County Recordei o/ the counry where f6e property is localed � ❑ County Auditor
on oi before January 5 oI the immediatety succeeding calendar yeac �� ry Recorder
2) Mobile /Manu(acfured Homes nof assessed as Real Property: Must file with (he CountyAudi(or ��
counry where the property is located dunng the Rvelve (12) months be/ore March 37 of each year f�8"�N n 8���
deduclion is sought.
See reverse side 7or addi6onal insfruc(ions and qualificalions.
ApDlitant (owne/ w xnVaG buyet - See 25mrlims on reverse side)
Jeffrey L. Mobley and Roberta L. Mobley
�adng �isintl Key number / legal descnp6on Record number Page num0er
Nontgomery 26-17-32-200-001.176-027 a� �� � ry
0.55essed value d reat prope .ry as ol Mongage / Contract inCeCteEness unpaid as of Mo�gage I Contrad irWebtetlness unpaid as of Is ihe applinnt Ne sole
hlarcht,airtentyrar Marchl,wrzentyear dat=otappicatian Iegalorequi�ablea.�neR
S„3.zoo.00 566,000.00 566,5oo.ao o Ye5 ❑ No
If no, wha� is his I �er euc� share of interest? If rnmed vnth someone olher than spouse, indicate wiU whom
I: name on recor0 is CiRerent Nan Ihat of applicant. intliwte belovc Is ��e pmperty In Quesfion: Annually Acsessed
Q Real Property ❑ MnualN Assessed
Rbbile Home QC 6-1.7-7)
Name of mon9a9ee or mntract seller
Heritage Federal Credit Union
Address of mori9agee or mnVact seller (num�er aiM streef, ury, safe, ariC ZIP code)
5388 Old SR 66, Newburgh, IN 47630
Name of assignee or oNer owner ar hdder of mortgage
Address of assignee (number antl sfreel. d1y, sfa;e. and ZIP code)
Does applican[ own pmperty in any o;her II yes, what coun;y? I What Tadng Disvict? Has ihis tleduc�ion Gcen reques;eC m property
councy in Intliana? ❑ O NO for wrtent yeaR � Ye5 ❑ No
Yes
COUNTY AUDITOR
Deduction apprwetl in rtie amount ol:
20 20 20 20 20 20 20 _
Signalure of Counry AuGi;or Co�nty Date (rtanlh, tlay, year)
�I 1 We certify under Ihe penal�y of perjury that the above and foregoing information is W e and correct and lhat lhe applicant is a resident of Indiana and
owner / conVact buyer of the aforementioned property on date application is fled.
Signa:ure wnefs (u' name) Date (rtronN, day, yeai)
12/02/2010
Full re ent tl� ss pplicant (rnm erarM sfr ury ,fate, and ZIP e)
9763 S 7 7 W, seyville, IN 7633
Person authorized by tluly executed Power ot Anomey b 6-1.142-0.7 �a:e (monlh, day, year)
ACtlress of autharixeG person (number arid �treeC cify, sfate. antl ZIP cotle)