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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
v_:. FOR DEDUCTION FROM ASSESSED VALUATION
.�_ 'y-�'} State Farm 43709(R11/6-09) eT • It
51 2013
�i� Prescribed by Department of Local Government Finance - File Mark
INSTRUCTIONS: 3i
To be felled In person or by mail. S{-P 2 3 .11.3'..1 Form fled with:
Fibng Dates:1)Real Property:Must be completed and dated in the calendar year for w}jS the deduction is sought. V Must be filed with the County Auditor or County Recorder of the county where the props u ' -:ted W County Auditor or before January 5 of the immediately succeeding calendar year.
z .r
2)Mobile/Manufactured Homes not assessed as Real Properly Must fit: ^I''i 4:- �� _ ❑ County Recorder
county where the property is located during the twelve(12)mone rpspy*GOiSi-(:.1 ear the
deduction is sought
See reverse side for additional instructions and qualifications.
App6cent(owner or contract buyer-see restrictions on reverse side)
Brian D. Nossett and Cathy A.Nossett
Taxing District Key number!legal description 26-23-16-200-001.830-024/2272 East Record number Page number
Presley Lane,Haubstadt, Indiana 47639
Lot 14,Country Ayre Estates Subdivision,Gibson County, Indiana / 3 5/ /
26-23-16-200-001.830-024
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage!Contract bdebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or eg equitable owner?$123,000.00
O Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse.Indicate with whom
It name on record is different than that of appacan6 indicate below: Is the property In question: Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street city slate and 71P We)
4401 rownerior holder - C 0P�
Name of assignee or other owner or nobler of mortgage
Address of assignee(number and sheet city,state,and ZIP code) /1 h -
Does applicant own property in any other If yes,what county? I f �/o t' f --67/ V on property
county In mdiana?
Drawer NO Q
❑ Yes ❑ No ❑ No
COUNTY/
Deduction approved in the amount of: Card NO.
20_ 20 20_ 20_ 20_
I I I
Signature ounty Auditor County Date(month,day.year).,
I/We certify under penalty of perjury that the above and foregoing information is true and correct and Nat the applicant is a resident of Indiana and
ow - /contract buyer of the aforementioned property on date application is filed.
Sig lyre owner's fun •me) Date(month,day,year)
Full rest.en!ad• lib-pptcant(number d street,city, e,and ZIP code)
2272 East Pre :, e,Haubstadt, IN 47639 q
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person(number and street city.state,and ZIP code)
I _