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. ^:ry STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_b 3 FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/614) )Y1��.,W /��� Zo1°� •
Prescribed by Department of Local Government Finance ��ll••''
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
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 the property is Lia7Ccunty Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County 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.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Colin Andrew Turner Chelsea Marie Turner
Taxing District Key number/legal description ' Rrxord n rter P a
UNION TWNSHP 26-18-28-100-000.126-025 L/ 00 U1 6nu�
Assessed value of real property as d 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?
0.00 210,208.00 El Yes 0 No
If no,what is his I her exact share of interest? If awned 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
(71 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contra seller J I 1 ;,f
Heritage Federerall Credit Union )
Address of ntngagee or contract seller(number and street,city,state,and ZIP code)
5388 Old State Road 66 Newburgh, IN 47630
Named assignee a other owner or holder of mortgage JUL 1 X 2019
Address d assignee(number and street,city,stare,and ZIP code) ,
Does applicant own property in any I/yes,what county? What Taxing District? GI •-f y�pe¢y R If yes,state amount of deduction
other county e
in Indiana? ❑Yes ❑No current year? ❑Yes U 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 d:
20 20 20 20 20 20 20
Signature of C A itor`ktiv '-'y County *t) / Date(mon de' v
isocm
I/We certify un er the penalty of p- -• at the above and foregoing information s t e and correct and that the applicant i a re Ant of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
y/e(ov/tels frN amp e)_ Date(month.clay.year) _ __
�' — fAh�(/��•� arf/rc— O6%2772019
Ft4I resident address of applicant(number and street.city,state,and ZIP code)
S 450 W Owensville, IN 47665
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.