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��; �*Ynv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
'` � FOR DEDUCTION FROM ASSESSED VALUATION
"'i'°.' ' 51 2012
%;� �� Siate Form 43709 (R71 / 6-09)
�'�f Presaibed by Department of local Government Finance File Mark
�e�•
INSTRUCTIONS:
To be nled in person or by mail.
Filing Dates: 1J Real Property: Must be completed and dafed in fhe calendar year tor which fhe deduction is sought.
Must be filed with the County Auditor or County Recorder ol the aounty where the property is located
on o� before January 5 0l the immediafely succeeding ca/endar year.
2) Mobile / Manufactured Homes not assessed as Real Property: Must �!e with the County Auditor of the
county where the property is located dunng the hvelve (72) months before March 37 of each yea� the
deduction is sought.
\ppiicant (ownei or contract buyer - se
fricia A. Evans
i axing District
(�?�G`��f
\ssessed value ot real property as of
Aarch 7, curtent year
f no. what is his / ner exad share of in
oi mortgagee or conVact 52IIE
age Federal Credit Union
ss of mortgagee or contrdtt sE
Old State Highway 66, N
of assianee or oNer owner or
ucant own pmperry m any
Indiana?
on reverse
Key number/ legal description 26-22-01-202-000223-009 / Property
512 West State Road 68 Haubstadt, Indiana 47639
�
-202-000.223-009
-202-000.223-009
rU 1, curtent year
10,000.00
i, IN 47629 —
mortgage \
yes, �
as oi mortgage i convact maeoteane
date of application
metl with someone other than spouse,
� le w :
� County uditor
N0� 13�, Recorder
UNTY q�p�TOR
3ecord number Page number
�p �� ���
s unpaid as of Is ihe apD��nt Ne sole
leg� o/r �quitable owneR
�Yes ❑ No
a� propeny in question: Annualty Assessed
Real Property ❑ Annually Assessed
Mobile Home (IC 6-1.
�l(CIV��j � r rl e1%L.
Dra`vcr 1`0 ...................
Card NO. ��.��.��...
; aeaucuon oeen reques�ea on properry
3nt yeaL�
❑ Yes ❑ No
J