Mortgage_Shepler,E n*. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Townshi Year
��%�°' FOR DEDUCTION FROM ASSESSED VALUATION �1
'���1 51 �j 20h3
\%� .�` State Form 43709 (R7 7/ 6-09) _
\�'�' Presaibed b De artment of Local Govemment Finance I 0 2f c
\
�a`�:� Y P
INSTRUCTIONS:
To be filled in person or by mail.
Filing Dafesr 7) Real Pmperty Must be completed and dated in the calendar year lor which lhe deduction is souqht.
Musl 6e filed with the County Auditor or County Recorder o/ fhe county where the property is locafetl
on or before January 5 0! the immediafely succeeding calendar year.
2) Mobile /Manu/aclured Homes not assessed as Real Property: Must (!e with the County Auditor o/ lhe
county where fhe property is located dunng fhe 6velve (tt) months 6elore March 37 0/ eacb year the
deduction is soughf.
pplicant (owner or con;rac: 6uyer - see restnctions on reverse side)
ames B. Shepler and Melanie N. Shepler
axin istrict Key number i legal description 26-12-06-401-OOOJ33-028 ! 1610
Brenhvood Dr., Princeton, Indiana 47670
ssessed value o( real property as of Mortgage / ContraU Indebtedness unpaitl as of Mortgage / Contra�
larch t, current year March 1, curtent year date of applica[ion
5141,000.00
no, what is his I her exacl share of interest? If owned with someone other
If name on recortl is tliflerent lhan Ih
Name of mortgagee or contract selle
Heritage Federal Credit Union
Adtlress of mortgagee or contract se
5388 Old State Highway 66, N
Name of assignee or other owner or
Atltlress of assignee (number and st
Does appliwnt own property in any i
wunry in Intliana?
❑ Yes
IN 47629
siate,
�No
FEB 2 7 2013
Form fled with:
� Auditor
GIB OM-COU MnAIHI��
as
legal or.equitable ovmer?
C�Yes ❑ No
spouse, indicate with whom
Real Property � Annually Assessed
Mobile Home fIC 6-1.1
n �;?���d:. l3 -/D�
Cal'v 1'�`�. ......
for curteni year?
on
COUNTY AUDITOR
Deduction approved in �he amount of:
20 _ 20 20 _ 20 _ 20 20 20
Signature of Counry Auditor Counry Date (month, tlay, yearj
I/ We certify under penaliy of perjury that the above and foregoing in(ormation is true and correct and that the appiicani is a resideni of Indiana and
owner I contract buyer of ihe aforementioned property on date application is fled.
Signatu owne�s:ul n m) Date (month, da , yea
y ri
F side t address acant (number and street, ciry, stafe, and ZIP code)
10 Brentwood Dr., rinceton, IN 47670
Perwn authorizetl 6y duty executed Power of Attorney or by IC 6-7.7-72-0] Date (month, dag yea�
Address of authorized person (number and streef, ciry, state, antl ZIP cotle)
