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,.���• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
, „ .a Count Township Year
�% FOR DEDUCTION FROM ASSESSED VALUATION 51 2012
�}' ` Sta,e Porm a3709 (R71 16-09)
'•:�%'• Prescribed by Department of local Govemment Finance IB f{
INSTRUCTIONS:
To be /illed in person or by mail.
Filing Dates: 1) Real Property: Must be crompfefed and datetl in the calendar year fo� �vhich (he deduction is soughL
Musf be filed �vith the County Audi(or or County Recorde� o7lhe county where the property is located
on or 6e%re January 5 0/ fhe immediately succeeding calendar year.
2) Mobile / Manulacfured Homes not assessed as Real Property Must file �vith fhe Counry Auditor o! the
county where (he property is located dunng the nveNe (72) monlhs 6e/ore March 37 of each year the
deduc(ion is souoh(.
nppucam �o�mer or con;�act ouyer - see re
Eric M. Rexing and Clara B. Rexing
Ta.ing Disirict .
on reverse
number / legal description 26-18-34-400-002200-024 / Property
W Soybean Lane Fort Branch, Indiana 47648
4, Harvesi Hills Subdivision Subdivision, Book B, Page 764, Gibson
inlv. Indiana
8-3a-400.002200-02a
Assessed value of real property as of Mongage / Contracl li
March 7, curtent year March 1, current year
5146,500.00
If no. �vha� is his / her exact share of interest?
If name on rewrtl is diHeren; than Ihat of applicaM, indicate belovr.
as
tlate of application
!:s� � ri
r n . . .
• �. - . . -
•• •�• ��� •'
ao �a
as
(�( 3a
legal or equitable owner?
G�Yes ❑ No
owned v+ith someone other ihan spouse. intlica�e vnth �vhom
ne pmperty m quesbon: Annualry Assessetl
Real Property ❑ Annually Assessed
Name of mortgagee or contract seller
BaNerra Bank
Atldress oi mortga9ee or contraG seller (number and stree�. ciN. state. and ZIP codel
133 Cross PoiMe Blvd., Evansville, IN 47715
name ot assignee or other owner or hoiaer o( mongage /� -- — —
Address of assignee (number and s7reeC city, s;afe, and ZIP rode -� 1.� 0 V I
/ ��/` �
Doesapplicamownpmpertyinanyother I(yes,whal Dra«'er Q,/�,'�/„�..
county in Indiana? / . -
Deduction approved in Ihe amount
2� � 2� � 2�
C�iCI ���� . .....................
2� � 2�
:tluction 6een requested on pmperty
year?
�Yes ❑ No
20 _ � 20
I/ We certify under penalty of perjury that the above and foregofng information is true and correct and that the applicant is a resident of Indiana ano
owner! comraa buyer of the aforementioned property on date application is filed.
SignaWre owners;uoname)
i, �. ���
Full resitlent atldress of applicant (number and streeL ciry, state,
2807 W Soybean �ane, Fort Branch, IN 47648
Perwn authorized by tluty ezecuted Power of Attomey or by IC f
person (numoer antl street,
(month, day, yea�
II-19� l�
(monfh, day, yea�