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CSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(Ri 1/6-09) 51 2014
Prescrbed by Department of Local Government Finance $ File Mark
al
INSTRUCTIONS:
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 Qc4y(ct ris t. /
Must be filed with the County Auditor or County Recorder of the county where ttl�ffrbpNti i n1i=ed (Z County Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the unty A itor
county where the properly is located during the twelve(12)months before Marc he
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Hannah R.Zunk
• Taxing District Key number/legal description 26-19-32-101-000.740-024/690 East Record number Page number
L)p''"v J Eisenhower Lane, Haubstadt, Indiana 47639 ) �
26-19-32-101-000.740-024 I )
I, As essed 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 oyequitable owner?
$102,400.00 :H,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: Is le property in question: Annually Assessed
75-Real Property ❑Annually Assessed
•
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Springs Valley Bank&Trust r
VCink Address of mortgagee or contract seller(number and str gah 11 IN �r NO 5/
Name of assignee or other owner or holder of mortgage r
Drawer NO
, Address of assignee(number and street,city,state,and oC
a J/�,�/
Card NO
,• Does applicant own property in any other If las this deduction been requested on property
county in Indiana? 4t0a 4/�, •-- x current year?
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature 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.
Si azure curers hill nom _re(month a yea
Full resident address of applicant(numbe and street, Ti sta e,and ZIP code)
690 East Eisenhower Lane, Haubstadt, IN 47639
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)