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„t.�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
SIN N FOR DEDUCTION FROM ASSESSED VALUATION
'i!�Gi= ( ) 51 2012
State Form 43709 R11 /6-09
IND' Prescribed by Department of Local Government Finance M
UCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 99 �9
Must be fled with the County Auditor or County Recorder of the county where the property is located DEC 7CbatRy Auditor
on or before January 5 of the immediately succeeding calendar year. c 4 n4.�n Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Mary Jo Bishop `96- ►q• 31-40o-00o• g31- bb9
Taxing District Key number/legal description Property Record number Page number
Address
Qtjeut
G 702 East Edinborough Court Haubstadt, Indiana 47639
PIN dg 16:1A15.Q
0`'7•`.,c.c,,�J�r{- �� (1L%7V
26-19-31-303-000.424.009
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
$204,600.00 II Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question: Annually Assessed
❑ Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Heritage Federal Credit Union
Ad • s of mortgagee or contract seller(number and street city state and 7lP code)
5 Id State Highway 66, Newburgh, IN 47629 -
Name of assignee or other owner or holder of mortgage - - -- --- , -
Address of assignee(number and street,city, state,and ZIP 640 /�,r, 7�I
Does applicant own property in any other If yes, Drawer 1O( � — �2•• this deduction been requested on property
county in Indiana? \/ merit year?
❑ Yes q\ No • ❑ Yes ❑ No
I\ Card NO.
Deduction approved in the amount of: .
20_ 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si� nature(owner's full name) Date(moat ,day,�Jye
Full resident address of ap'ccan (number street,city, state,and ZIP code) �� J ���'
702 East Edinborough Court, Haubstadt, IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person(number and street.city,state,and ZIP code)