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.���'—"'�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township I Year
}•;: i 1 FOR DEDUCTION FROM ASSESSED VALUATION
StateFwma3709(R10/71-08) Gibson Union
�' � PresaiGed by Department d Loral Govemment Finance
INSTRUCTIONS: TT11 FI
To be fileC in person or by mail wilh tlie CounryAudiroi o! fhe cowty whera fhe p�operty is located. 0-�1 �� �
Filing Dates: 1� Real Property: Musf fJe dunng Ne year for which fhe deduction is soughL 1� g L
2J MoOtie /Manulac(ured Hwnes not asseuetl as Real Property: Must file dunng the IweNe (12) mon(hs belore March 37 0l each year
Ihe deducfion is sought. 1
See �everse sitle (or addifional instructions and qualilwtions. �AN 1`1 2��3
.lpqicant (mmer cr contrau cuyei- see restrictions m reverse side)
Tamara S. Rexing
Taxing0i5Uip KeynumGer/legaldesoiptim �,�(BS' A
Union 2G7&23200-002.30S025IP1 a( the SE atr. of the NE QV. of Sec. cy
Assessed vahie of real property az ol Mortgage / Contraa iMebtednass unpaitl as of Mort9age I ConVatl indehtetlness unpaiE as o� Is �he appLrant Ne sde
Martli 1, nrtrent year MarU� 1, curtent year date of apptication legal w eQurtaWe owne(1
$119.200.00 0 Yes ❑ No
II no, wlut is his l �er exact shara af intaraSl? I It owneE wiN mmeane other Vian spouse. intllrate wiN whom
II name on recorE is diEerenl Nan NaI ol applicanl. inCiwle bebw: Is Ne property i^ QuesUOn: MnuaDy 0.ssesseE
❑X Real PropeM ❑ MnuallyASSessed
Mobile Home (IC 61.1-7)
Name of morigagea w convad saQer
Heritage Federal Credit Union
Adtlress of mortgagae or mnvatt seAer (numDer arM sveel, �ily, slare, aM ZIP coEe)
5388 Old State Rd. 66 Newburgh, IN 47630
Name ol assignee or o�er ownar w hddar W mwtgage
ACarass ot auignee (numaer antl sLCaG r1y, stafe, a�M ZIP cotle)
Dces apdiwnt mm property in any oNer If yes, what cwnry? Y.Tat Tacing Distria7 Mas Mis deduawn been requestea m property
counh �n I�iana? ❑ ❑ fw curtent yea(.+ � Yes
Yes No ❑ No
COUNN AUDROR '
Deaucnon appmveC in Na amount ot
20 _ 20 _ 20 20 _ 20 _ 20 _ 20
Sgnature ol Counry Autlitor �nry Date (monN, Gay, yea�
I/ We certify under 1he penalry of perjury ihat che above and (oregoing informalion is we and cortect arM that Ihe applicant is a residen[ of Indiana and
owner / wn[ract buyer of lhe aforementioned property on dale applica6on is fded.
Signawre lowners hdl name) Da�e (monN. CaY� Vaa)
� ' '�� Z
Y resiaem aooress ol appticant (nvm�er a suee( , itaro, arM Z!P catla)
1246 W. 900 S. Ft. Branch, IN 47 8
Person auNOr¢ea Oy Cuty ezewte� Power olMOrney a Gy iG 67.1-12-0.7 Date (mm�n, tlay, yea�
Atltlress o/ auNwceC person (numner and woet ciry, stare. erM ZIP code)