HomeMy WebLinkAboutMortgage_Adams (7).��, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i�4 FOR DEDUCTION FROM ASSESSED VALUATION
� � r State Fwm <3709 (R10lii-08)
� Prescnbed by DepaNnem o/ Local Govemment Finance
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Count � Township � Year
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INSTRUCTIONS:
To be Filed in person or 6y mail wiih the County Audimr o/ the counry where fhe property is loca(ed.
Filing Dafes: 7J Real Property: Must file dunng the year for whicb fhe deduction is sought. 16 N}� 7��� .
2J Mobila /Manufacfured Homes not assessed as Real PropeRy: Must file dunng fhe hveNe (72) months 1S�/drb 16� hcYl I eacn year
the deduction is sought.
See reverse si0e !or additional insfruc6ons antl qualifications.
npD���m�ownerorrontraaeuyer-seerestrictionsonrcversesiee) ;,o.,a,.s..,��:-_. _. _ . - (31B$01r ('.QUI�TYAlJD1�8040000
Mark D. Adams & Shawny D. Adams - xo�..-���.�.- -��z _=-__ �
Taring DisMct Key number / legal descnptiori" �—� ��
F} (JrQy�� 26-7378-701-001.003-026/Lot 17 in the Northem tl2 of lot 16
Auessed vaWe olreal property as of Mortgage / Conlraa iMebtadness unpaid as of Mortgage / Con;raU indebtedness
Mart�h 1, artent year March i. cunent year tlate of apolication
S 7 60.000.00
It no, what is Ns / �er e�U s�are ot interest?
If name on recorG is diRerent Ihan Nat af appGcani, iMicale bebr.:
Name of mongagee or conVaa seller
United Fidelity Bank fsb
Address of mortga9ee ar conVact seAer (numberantl sireet, ciry, stare, and ZlPcode)
18 NW Fourth St. Evansville, IN 47708
Name of azsignee or other owner or holder of mortga9e
AECress of assignee (number antl sveaC ciry, stata, anC ZIP code)
Oces app4wnt own pmperty in any oNer If yes, what counry?
caunry in InOiana? n Yes n No
wmeone
What Taaing Disirict7
R}�i'.]�imP�pl91 I Page number
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34.nn
Is ihe property in Question: MnuaDy Assessed
❑X Real Property Q MnuallyAssessed
Has Nis deCudim been requestea on properry
Iw cunent veaR ,--,
I�G7
LOUNTY AUDITOR
Deduction approveE in Ne amwnt of:
20 _ 20 20 _ 20 _ 20 20 _ 20 _
Syna:ure of County Autli:or Counry Data (mmN, day, yea�
I I We certity under Ihe penalry of perjury ihat Ne above and toregoing infortnaUOn is We and cortect and that the applicant is a resident of Indiana and
owner I contracl buyer of the forementioned propeRy on date application is filed.
Nre (ownefs :WI nem ) Date (monN. tlay, yea�
� �0 12/2612012
Fu0 reSiEent aCEress o apPli nt (number arrd sveet. ciry, state, a� P e
905 Mohawk Dr. Ft. Branch, IN 47fi48
Person auNonzeE by tlury executed Power W Attwney or by IC 61.142-07 Date (rtronlh, Cay, yea�
Atltlreu of auitfor¢eC person (num0er arM saeel. ciry. state. aM ZIP coCe)
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