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t^•�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
t',VV �a
4��^ �`?' FOR DEDUCTION FROM ASSESSED VALUATION
'� —.- 51 12
+-
3 �' State Form 43709 (R71 / 6-09)
'��� Presaibed by Department of Local Government Finance II M f
4u
INSTRUCTIONS:
To be (Iled in person or by mail.
Filing Dates: 1) Real Property: Must be completed and dated in the calendar year(or which the deduction is sought.
Must be filed with lhe County Auditor or County Recorder o/ fhe county where the property is located
on or befo2 January 5 0/ the immediately succeeding calendar year.
2) Mobile /Manufactured Homes not assessed as Real P�operty.� Must (le wifh the Counly Auditor o/ the
counry where the property is located during the hvelve (72) months belore March 31 0( each year the
deduction is sought.
See 2verse side for additional instructions and ualifications.
Applicant (owneror contract buyer- see resMcfions on reverse side)
Lee Penner
��G��
ssessed value of real property as
7arch 7, current year
name on rewrtl
number / legal description 26-1036-200-003.817-021 / Property
S 700 W Owensville, Indiana 47665
10-36-200-003.817-021
Evansville Teachers Federal Credit Union
Address of mortgagee or wntract seller n m •
4401 Theatre Drive, Evansville, IN 47715
Name of assiqnee or omer owner or
o( assignee
applicant own property in any ot�er
y in Indiana?
❑ Yes j
ction approvetl in ihe amount oF:
20 _ 20 _
arch i, wrtent year
143,000.00
below:
and ZIP mde)
zo
unpaid as
appliwlion
someone
. , �
.. .
�■ . o. - . .
� .. ..-
Rewrd number Page number
��i� .so2�
ebtedness unpaid as of I5 the appliwnt the sole
legal or equitable avneR
�Yes ❑ No
spouse, indiWle with whom
ie property in queslion: Annualty Assessetl
Real Property ❑ Annualiy Assessed
�,��� /�-sv8a
r m bee
D1'a��'er \0 ...................
Cal"(11'� . ..................... —
zo _ � 20 _ � 20 _
Date
on pmperty
❑ No
zo _
I I We certify under penalty of perjury thai ihe above and foregoing information is true and correci and that the applicant is a resideni of Indiana and
owner / contra buyer of the afore entioned property on date application is filed.
ignature (ow s fu nam�) Date (monih, day, yea�
� 9�d�8-a�la-
��n rnsin � adAress of aoolicant InGmber and street, city, sfate, antl ZIP code)
700 W. Owensville, IN 47665
or
person (number and streeG city, stafe, and ZIP cotle)