HomeMy WebLinkAboutMortgage_Davis (30)FI���I� �
FEB 2 0 2013
`'.�,..'•o STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS Co ar
i� FOR DEDUCTION FROM ASSESSED VALUATION
3� SuteFOrma3709(a77/6-09) Gibson Haubsladt
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Prescn0ed by Deparimem ol Local Governmem Pinance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed wim:
Filing Dates: 7) Real Property: Must be complefed and dafed in the calendar year Ior which fhe deduction is sought.
Must be filed wi(h (he Counry Auditor or Counry RecoNer o/ ihe county where the piopeRy is located ❑ Counry Auditor
on or before January 5 olthe immetliately succeeding calenda� year. ❑ County Recorder
2) Mobile / Manufactured Homes nof assessed as Real Property: Must file with the CountyAuditor oI the LI
counry where (he property is located dunng the Rvelve (12) months before Ma/ch 37 0l each yea� fhe �-
deduction i5 sought.
JCC /CVClJC .IIVC I V/ OVV/UV/101IIIp111I1.(Nlli O/IY I�YC/1114OIIUIIi.
AppGcant (owner or rnntrac! buyer - see resNrlions on reverse vtle)
Stacy L. Davis
Tazing Distria Key number / le9al tlesvip�iw� rReaea ahA�cer 19„ • a �-
Haubsladt 26-19-31-301-000.241-009 hLot_726.& Pl1ot 125 Town of Haubstadt Instrunent
Assessed value of real property as ot Mortgage / Convact irWebteAness unpaid as of --Mortgage I ConVaG indebtedness m,µuu�.q> o' �e appli�`au e so e
Marrh 1, artent year March 1. wrrent year --- --- tlate of appGcation - � I or equitable owneR
$72,200.00 ❑� Yes ❑ No
it no, whdl is his / Iler ez2U sh2re of interesi? If owneG with SOmeone other (h2n sP0U5e, ilWifate wiih Whom
If name on record is diHerent �han Nat of aOPGwnt, indicate below: �s Ne propetty in question: Mnvalty Assessed
❑� Real Property ❑ Mnually Assessed
Mobile Hwne (IC 6-7.1-7)
Name ol mortga9ae or convacl se0er
Herilage Federal Credit Union
Address of rtqrtgagee w mnUact seDer (numbei and street, ciry, s(ata, aM ZIP codej
5388 Old State Rd. 66, Newburgh, IN 47630
Name ol assignee or oNer owner w holtler o1 mortga9e
Atltlress of assignee (numberand sfreet, dry, sfafe, and ZlPcode)
Does apD�iwnt rnm pmperry in any other If yes, what couny? What Taxing Distria7 Has Nis tletluction Deen repuested on property
counry in InEiana? for current yeaR
❑ Yes ❑ No ❑ Yes ❑ No
COUNTV AUDITOR
Oeduction apprwee in Ne amount of:
20 _ 20 _ 20 _ 20 20 20 20 _
Sgnature of Counry AuEitor Counry Date (mrnN, tlay. yean
I I We certify under the penalry of perjury thal the above and foregoing information is true and correct and that the appliwnt is a resident of Indiana and
owner / contract buyer of the aforementioned property on date application is filed.
Signature s full name) D�i�or fn, . y,
�
L v
Fu0 addressolapplican mberan ee,nfy,slate,aiMZlPCOde)
119 N. Vine St., Haubstadt, 7639 -
Person auNOrizeE by Cury e.ecuteE Powrs of Attomey or Dy IC 64.142-07 Date (mmN. day. year)
Address of authorized person (number and sveet, city, sfate, and ZIP wde)