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•ep rt"a4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I Township. Year
E = FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) 2014
• '' Prescribed by Department of Local Government Finance !t 1�
Ff- ar i
INSTRUCTIONS: 1 t
To be tiled 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. Ji &&r2Q44ditor
Must be filed with the County Auditor or County Recorder of the county where the property is located LJ
on or before January 5 of the immediately succeeding calendar year. - I ❑ County Recorder AUDITOR
2)Mobile/Manufactured Homes not assessed as Real Property:Must Me with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the If�aW
deduction is sought. IGIBSON COUNTY
See reverse side for additional instructions and qualifications.
Appbcant(owner or contract buyer-see restrictions on reverse side)
Chad A Kingsbury
Taxing District I Key number/legal description Recordpumber Page number
Gibson I 26-12-09-103-001.612-027 I y ,- 0 .
IAssessed 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 I legal or equitable owner?
600.00 182,750.00 219,387.00 O Yes ❑ No
I If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
1 If name on record is different than that of applicant,indicate below.- Is the property in question:Annually Assessed
TA Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
IName of mortgagee or contract seller
Hallmark Home Mortgage, LLC
Address of mortgagee or contract seller(number and street.city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state.and ZIP code)
I
Does applicant own property in any other If yes.what county? What Taxing Distnct? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes No I TA Yes ❑ No
I - COUNTY AUDITOR
IDeduction approved in the amount of:
20 20 20 1 0 20 20 20
ISignature of County Auditor County I Date(month.day,year)
II/We certify under the 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.
I ignature nets 1u9 '' I I Date(month,day,year)
1214!2013
Iru esident address of applicant(number and street.city,state,and ZIP code) I
Lot 7 Indian Creek Drive,Princeton, IN 47670
I Person authorized by duly executed Power of Attorney or by IC 6-1,1-12-0 7 I I Date(month.day.year)
Address of authorized person (number and street,city state.and ZIP code)