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n•>:o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
C `v FOR DEDUCTION FROM ASSESSED VALUATION
1k 2016
S,i�,-_. + State Form 43709(R12/614)
<- / Prescribed by Department of Local Government Finance File Mark
INS`TRUCTIONS: $!�
To be filled in person or by mail. 1 I T y . Form fled with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is soug t. L,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 6�1
property is located on or before January 5 of the immediately succeeding calendar yeA}J G 2 4 �f116 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor o ms 0 County Recorder
county where the property is located during the twelve(12)months before March 31 of ach year the
deduction is sought
See reverse side for additional instructions and qualifications. CIDSOr
Applicant(ownerorcontractbuyer-seerestrictionsonreverseside) LUU TYAUD!TOR
Kevin L.Mulvaney and Michelle L.Mulvaney
Taxi Distil t Key number/legal description 26-23-16-200-001.905-024/2107 Presley Record number Page number
Th------ Lane, Haubstadt, Indiana 47639 I1 Cy 3U 02
Assess d 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?
$252,000.00 'tidies ❑ 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
4Real 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 —v 1
Name of assignee or other owner or holder of mortgage t�eJ (``(,�, �,_, °F M1G� t l�C
1"1 L.-1\I av--C1 It 0 \-k- c.--1/43---
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Address of assignee(number and street,city,state,and ZIP code) Drawer N O d-o \�Q
Does applicant own property in any If yes,what county? What Taxing Distric 4 a 5 ,u� •�?�`1 r :ate amount of
other county Card NO. `� lC r n
in Indiana? ❑ Yes F. No
A person is not entitled to this deduction unless the person has a balance on the pen _ ._ _._._._-___:in the county
recorder's office(including any home equity fine 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_
n
Signature of my Auditor• / County I Date(month,day,year)
I/We certify under Pena of perjury that e . e and foregoing ormation 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.
Signature(owner's full name) Date(month, day,year)
Full resent address of applicant(number a reet,-city, state,and ZIP code)
2107 Presley Lane, 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_ r� 4�