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d���o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
;i _rtV . 1 FOR DEDUCTION FROM ASSESSED VALUATION
� Sta•s Fortn 33709 (Rt 7/ 6-09) _
��"�,.,. '� PrescnCeE Oy Depertment of Local Cwvemmen� Financa
INSTRUCTIONS: File Merk
To 6e l/ed in person or 6y mail. Fwm filea with:
Filing Dates: 7) Real Pioperty: Must be completed and dated in fhe calendar year7or which fhe deducfion is sou ht.
Must 6e filed with fhe County Audito� oi County Recorder o7 fhe wunty whe2 the property is 1 e �'4u �
on or 6efore January 5 0( the immediately succeeding calenCar year. Co R rder
2) Mobile / Manu/actured Homes nof assessed as Real Properfy: Must file wifh !he County Auditor he I
� counry where 1he ploperty is located dunng the fweNe (f2) monfhs 6efore March 31 oteach year e
deduction is soughL AIf1U 4�n %��%
See reverse side Ior additional instructlons antl qualifications. ^" '°—. �;
Appticant (owrrer w cantrart buyer - see resvictions m reverse side)
Michael A. & Michelie L. Freeman C'�'
Tadng Districl Key number/ legal descno� Record number ���t
Union Township 26-19-09300-001.143-025 / Pt NE 1!4 SW 1/4 93-10 G SON COUNTY �120AD06134-
Assessed vaNa M real yoperty as ol Mortgage / ConVaa indeCteEnass unpaid a5 W Mortgage / ConVaG inEebtedness unpaitl as of Is Na applicant Ne sde
MarN 1, artent year March 1, curtent year date of appliration legal or equifade wmerl
5225,600.00 ❑/ Yes ❑ No �
I( rro, what is nis / her exaU share of interest? If owned with wmeone other Uun s �
pouse. inOicata with xTOm
It name on record is Oifterent Ihan lhat ot appticant. inEicata bebw. Is Ne property in questim: MnuaOy Assessetl
❑� Real Propeny � MnuallyASSessed
� Mobile Home (IC 61.1-7)
Name of mortgagee w wnVatt saller � \�
Heritage Federal Credit Union J
AEaress of mwtgagee w mnVaci seAer (numDer arM streef, ary, s1a.e. a� Z!P cotle) �
5388 Old State Rd. 66, Newburgh, IN 47630
Name oi a55ignee or oNer wmer or hoker of rtwrtgage
AOdress of assgnee (number anC ineeq pry, sfafe, and ZlPCOde)
Does applicani own prope�ty in any oNer If yes, what munry? KTat Tazing OisVict7 Has ihis deduction been requested on property
counry in InGiana? for curtent Yeart
❑ Yes ❑� No ❑ Yes ❑ No
COUNTY AUDITOR
�educlion approved in ine artaunl oC
zo zo zo 2o zo zo zo
Sgnature of CountyAudi.or Counry Date (rtronN, day, yea^
I 1 We certify under the penalty of perjury that the above and foregoing intormatlon is Vue and cortect and Nat the aDG�icant is a resident of Indiana and
owner / conVaU buyer of the aforemenGoned property on date application is filed.
Signa:ure(owners/Wlname) �� 1 Datf �day,yea�
�•'1 `u.C.�KA.4L).V iX R 11fY� n' \40.1`(�� y C1
Fu0 resitlent aECress of applicant (�umberand s/ree( city, slate. antl ZlPcotle)
6192 S 175E, FL Branch, IN 47648
Persan auNOrizeE by Euly execuied Power otAttomey or by IC G1.1-12-0J Dare (month, day, yeaQ
Adtlressatauthoraetlpersan (numberaMsLeef.ary,state.errdZlPtoda)