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<i`, r=.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
d < FOR DEDUCTION FROM ASSESSED VALUATION
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;i %.. State Form 43709(R11 /6-09) 5 2013
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•::�a Prescribed by Department of Local Government Finance I e afk
INSTRUCTIONS: OCT 2X 2013
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located /I, ,sl-firth: ; my Auditor
on or before January 5 of the immediately succeeding calendar year. I gS0 C�iINTI'Gmtl[T)1FZi�lyder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of fhcG
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and Qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Peter Price
Taxing District Key number/legal description 26-18-24-202-001.140-026/600 South Record number Page number
Cumberland Street, Fort Branch, Indiana 47648
26-18-24-202-001.140-026 a D<3 55 “
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legetof equitable owner?
5163,200.00 I !,c Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
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If name on record is different than that of applicant,indicate below: Is ttre property in question: Annually Assessed
'CE/Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Federal Credit Union - — -- - -- _
Address of mortgagee or contract seller(number and street city state and ZIP code)
6209 Vogel Road, Evansville, IN 47715 ���3
Name of assignee or other owner or holder of mortgage Drawer NO
Address of assignee(number and street,city,state,and ZIP code) rr) /i-1
Card NO. ! 5 C.-(/-(`(/�/
Does applicant own property in any other If yes,what county? What Taxir l perty
• county in Indiana? -
❑ Yes No I u 1 ea ❑ No
i
COUNTY AUDITOR I
Deduction approved in the amount of:
20 20 20 20 20 1 20 20
Signat re of County Auditor County Date(month,day,year)
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Snature(ow s ulln )e Date(month,day,year)
- A??-17— /3
Full resident address of applicant(number and street,city,state,and ZIP code)
600 South Cumberland Street, Fort Branch, IN 47648
Person authorized by duly executed Power of Attomey 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)