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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)