HomeMy WebLinkAboutMortgage_Chaddock II a��A' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tee _ IL FOR DEDUCTION FROM ASSESSED VALUATION
3:� State Form 43709(R71 /6-09) 51 2014
' v Prescribed by Department of Local Government Finance File Mark
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INSTRUCTIONS: �T �
To be filled in person or by mail. 'ek'? Form filed with:
Filing Dates: 1)Real Properly:Must be completed and dated in the calendar year for which the d duct n SQtr t.
Must be filed with the County Auditor or County Recorder of the county where the property is orated ❑ 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 Couregbd4o f f4 4
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. I ti:cm �
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
John A.Chaddock II and Lisa A. Chaddock GIBBON COUNTY AUDITOR
Taxing District Key number/legal description 26-23-16-200-002.483-024/1689 East (Record number Page number
Lincoln Pass, Haubstadt, Indiana 47639
Lot 24,Warrenton Place South, Gibson County, Indiana
26-23-16-200-002.483-024 /e4—3 /q
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 legal or equitable owner?
$342,000.00 0 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 the properly in question: Annually Assessed
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Heritage Federal Credit Union
Address of mortgagee or contract seller(number and street city state and 7IP rode)
5388 Old State Highway 66, Newburgh, IN 47629
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 0 No ❑ 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.
natur owners f - 8 X Date(month, ay,year)
Si 4/ dent address of-•.lint(number and street,city, state, and ZIP code)
/ /
1689 East Lincoln Pass, 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)