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?a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township ( Year
FOR DEDUCTION FROM ASSESSED VALUATION L
?' State Form 43709(R12/614)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. AUG 2 U 2014 Form lied veil:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. •
Must be filed or postmarked with the County Auditor or County Recorder of the county where t roperty is ❑ County Auditor
located 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 Cour ,9y_d/(
where the property is located during the twelve(12)months before March 31 of each ye tttl 'gi4UD1 I OR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
WAYNE T. HARLESS
Tam District Key number/legal description Re number P number
26-12-07-102-002.697-028 1 Sal
value property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
ii Iur`J
M , � o March 1,current year date of application /� legal or equitable owner?
�/027/ toil Oa ❑ Yes ❑ No
It no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is dfferent than that of applicant indicate below: Is the property in question:Annually Assessed
171 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
VETERAN'S UNITED HOME LOANS
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1400 VETERAN'S UNITED DRIVE, COLUMBIA, MISSOURI 65203
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 If yes,what county? Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes No current year? ❑
❑ El Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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 I We certify under the penally 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.
Sig cure(o ers lull na / Date(month.day,year)
07/ Ito /2014
Full resident dress of applicant(number nd street city state,and ZIP code)
609 N. Main Street, Pr' ceton, Indiana 47670
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Dale(month.day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.