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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R71 / 6-09)
Prescribed by Department of Local Government Finance
Coun Townshi Year
51 2012
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INSTRUCTIONS:
To be fil/ed in person or 6y mail.
Filing Dates: i) Real Property: Must be completetl and dated in the calendar year (or which the deduclion is sought.
Must be Tled wilh the County Auditor or Counry Recorder of fhe county whe2 the property is located
on or be/o2 January 5 of the immediate/y succeeding calendar year.
2) Mobile / Manufactured Homes not asseued as Real Property: Musf �le with the County Auditor o1 the
county whe2 the property is bcated dunng the hvelve (12) months before March 31 0/ each year the
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F°"`� f��"�n3 2012
� County Auditor
o- � corder
deductionissought. GIBSON COUNTY AUDITOR
See reverse side for additional insfructions and ualifications.
AppliWnt (owneror tontrdct 6uyer- see restnclions on 2verse Side)
Timothy E. Dutkiewicz and Amy B. Dutkiewicz
Taxing District Key number I legal description 26-23-07-100-002.430-024 / Pfoperty Record number Page number
Address
L�� 5 West 1100 South Haubstadt, Indiana 47639 rn
PIN 1�1C/� � 3�� /
26-23-07-100-002.430-024 �
Assessed va ue of r I property as of Mortgage I ConVact Indebtedness unpaid as of Mortgage / ConVact intlebietlness unpaid as of Is the applicant ihe wle
March 7, current year March 7, current year date of aDG����on legal or equitable owner?
5251,000.00 O Yes ❑ No
If no, what is his / her exad share of interest? If owned with someone other than spouse, indiwte with whom
If name on record is different than that of appliwni, indicate below: Is ihe property in question: Annualy Assessed
O Real Property ❑ Annualiy Assessed
Mobile Home IC 6-1.1-7)
Name of morigagee or contraci seller
Evansville Federal Credit Union
Address of mortgagee or wntract seller (number and sireet. ciN. state. and ZIP cotle)
6209 Vogel Road, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address oi assignee (number and stree( ury, sPate, and ZIP code)
Does applicant own property in any other If yes, whai counry? What Ta�cing Disirict? Has Nis deduction been requested on property
counry in Indiana? for curreni year?
❑ Yes O No ❑ Yes O No