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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wit , Year
b FOR DEDUCTION FROM ASSESSED VALUATION Si
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s State Form 43709(R13/10-15) i
Prescribed by Department of Local Government Finance a ,—.
Filegat
INSTRUCTIONS: 4
lb be filed in person or by mall ' Form filed
Filing Dates: 1) Real Property Must be completed end dated in the calendar year for which the deduction is soughtQ)p,, ou Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property@ ..
located on or before January 5 of the immediately succeeding calendar year. N .2_CO th r T`.' - •Cr
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. 'ill
See reverse side for additional instructions and qualifications. '/Op
Applicant(owner or contract buyer-see restrictions on reverse side)
Newman, Bobby W. and Newman, Tabitha A.
Taring DIsbin Key number/legal description Record number Page number
Union 26-18-26-300-002.090-025 02-0 /8 - r1,--/at
Assessed value of real property as of Mortgage/Coraract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessmentdab,current year assessment date.current year date of application legal or equitable owner?
$237,500.00 0 Yes 0 No
d no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record Is descent than that of applicant,indicate below. Is the property in question:Annually Assessed
0 Real Property 0 Annualty Mobile Home sC Assessed1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street city.state,and ZIP code)
One Main Street, Evansville, IN 47708
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,stale,and ZIP code)
Does applicant own property in any If yes,what county? Mat Taring Disthct? Has this deduction been requested If yes,state amount of deduction
other county on
in!miens? ❑Yes DNa current year?tor ❑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 Aud'aor County Data(month,day.year)
I/We certify under the 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 flied.
Signature(owners full name) Date(month,day,year)
`�akili1A A.1U.wman GeV tv ------ /0 is/J
Full resident address of applicant(number and street state.and ZIP code)
2230 West 950 South, Fort Branch, IN 47648
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,dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 110,000.