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,.•'*•'• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. Year
cti FOR DEDUCTION FROM ASSESSED VALUATION
3� ` State Form 43709(R11 /6-09) 51 2013
\;•:.......W.y Prescribed by Department of Local Government Finance `' - FII*a .
INSTRUCTIONS:
To be filled in person or by mail. 1,Fpm f
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. DE , (r'J 1013 ith:
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. r), ❑ ntv Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ,Il�lLt
county where the property is located during the twelve(12)months before March 31 of each year the
lBSON COUNTY AUDITOR
deduction is sought. U
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Lori J. Shake
T�J�r�ax District Key number/legal description /521 West Cleveland Avenue, Princeton, Record number Page number
7 tff-oLwe,' Indiana47670 26-/Z-l8- 3o/_ 00 ,, . P-10- 0 ‘2. 7 /3 6,6V Y
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 legal or equitable owner?
5115,425.00 O Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: ��,1 --I---•'^°'inn=Annualty Assessed
V i „ I I „ ivally Assessed
�(!�.( LC ``''��11 I s Home(IC 6-1.1-7)
Name of mortgagee or contract seller Drawer 1NO. [:!r((Q
I
Evansville Teachers Federal Credit Union I`C!t .11-9-
Address of mortgagee or contract seller(number and street,city state and ZIP code; •
4401 Theatre Drive, Evansville, IN 47715 Card NO.
.................... .
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP code)
•
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes O No • ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20_ 20_ 20 20_
Signature of County Auditor ���� ���7 , County Date(month,day,year)
/We/We ceenalty of of perjury 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 da application is filed.
Se na ure( w ers full na � Date(month, day,year)
ull -silk -p of appli (number street,city,state,and ZIP code)
521 CI-• -nd Avenue, eton, IN 47670
Person authorized by duly 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)