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d��A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I Township Year
;x� FOR DEDUCTION FROM ASSESSED VALUATION
'�l• Stata Form d3709 (R70/11-08) Gibson Johmm�
- Presaibed Dy Departmeni W Local Governmenl Finarica
INSTRUCTIONS: File Mark
To 6e filed in person oi by mail wifh Ne CounryAudiror o1 the counry wAe2 the properry is located.
Filing Dates: 7) Real PropeRy: Must file dunng tAe year lor which the detluction is soughf.
2) Mobile /Manulactured Homes nof assessed as Real Property: Musf file dunng the hvelve (72J months betore March 31 0/ each year
!he deduction is sought.
See reverse side !or atldifional inslruc(ions and qualificafions.
Applicant (owne� a confracf Duyar � see iesfricfions on 2verse sitle)
Steven J. Wlzbacher and Linda L. Wilzbacher
Tawrg Distrid Key number / legal destriOYqn Record number Pa9a number
Johsnon 2E23-02-200-001.954-024/Lot 9 in Oakridge Estates Sub Sec. A Q � 5
Assessetl vaGia d real praperty as W Mortgaga / Contraa intlebtedness unpaid as of Mortgage / Con;raq indebtednass unpaid as of Is iha applicanl Ne sde
Maich 1, curretrt year Marfh 7, curtent year Eate of appGCatbn legal ar cquitade owneR
S59,500.000 ❑X Yes ❑ No
If fa, what is his I her exaU shara ol interesl? If o+meC HiN someone oNer Nan spouu. indinte wiN wtwm
If name m record is EiRerent tnan Uat of appGrant, inairate Eebw Is Ne property in Question: MnuaDy Assessed
❑X Real Property ❑ MnualyASSessed
Mobile Home (IC 61.1-7)
Name of mortgagea or mnVact seDer
Hentage Federal Credit Union
IAddress of morc9a9ee w mnVact se0er (number and street, ciry, stala, aM Z/P code)
5388 Oid State Rd. 66 Newburgh, IN 47630
Name o/ assignee or oNer owner or hdtler o( mof.gage
ACdress of assignee (num0er arM sree4 �}; slate, and ZIP to0e) -
Does appficant own properry in any oNer It yes. whal cwnty? What Taxing Distriu? Has ihis deduaion been requested m properry
counryinlnd'unal ❑ No forcurtentyeaR � No
❑ Yes ❑ Yes
COUNTYAUDROR
�eductlon approveE in Ne amount oC
20 20 20 20 20 20 20
Sgna;ure of Counry AuEitw Counry Date (mmN, Cay, yea�
i/ We certify under Ihe penally of perjury that Ne above antl (oregoing infortnation is we and cortect and that the applirant is a resident o( Indiana and
owner I conVaG buyer of lhe aforementioned property on date applicaEon is filed.
S' amre (mme/s lull n ) Date (monN. day, yee�
10/19/2012
u0 resitlent aOEmss of a cant (number and sbaef. ciry, ifafe, e IP coCe)
4084 E. Oakridge Estates Haubstadt, IN 47639
Person authwizeG by duy exewted Power of Attwney or by IC &1.142-07 Da[e (mmN, tlay, yea�
ACtlress af auUaraed person (numhe� arM streef, nty. sfate. aM ZIP coda)
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