HomeMy WebLinkAboutMortgage_Church AC STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
al;d ?e FOR DEDUCTION FROM ASSESSED VALUATION
4�/ i State Form 43709(R11/6-14) 2015
Department of Local Government Finance F$'i�`�II
rsu Prescribed b y p F I ., a It%
INSTRUCTIONS:
To be filled in person or by mail. ),e�( ith:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JUN F-0 fL
Must be filed or postmarked with the County Auditor or County Recorder of the county where the County Auditor
property is located on or before January 5 of the immediately succeeding calendar year. Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the .
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. talBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Aaron M.Church and Jess' M. Church
Taxi District Key number/legal description 26-18-36-300-002.573-024/10439 South Record number Page number
Pheasant Run, Haubstadt, Indiana 47639 /�13$(p
As ssed 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 legator equitable owner?
$172,000.00 iloYes ❑ 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 property in question: Annually Assessed
'f;;.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 ZIP code)
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 If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes 'No current year? ❑ 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
I W®under penal y 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.
Sign lure(owner's full nanlg7 ,. (\ O Dale(month,day,yew)015
aant iXl r�fvep� �F J
Full res a address of applicant(number and street,city,state, and ZIP code)
10439 South Pheasant Run, Haubstadt, IN 47639
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.