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• - • STATEMENT QF.MORTGAGE.OR CONTRACT INDEBTEDNESS.: -.*:.:-Ciiiinty.
Township Year
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FOR bEDUCTION,FROWASSE8SEOVALUATION:...
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i State Form 43709(R13 i 10-15) GIBSON Johnson '...':%.----i--4. Prescribed by Department of Local Government Finance
.:'•-" File Mark
kittRUCTiONS:
To be.filed in person or.byrnair. Form MedWiUr
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction Is sought.
Must be moo orpostaiorked with the Pew:sit:Auditor or County Recorder of the county Whore the property Is IZI county Auditor
located on:orbefere January 5 of the immediately succeeding calendar year. 0 Count/Recorder'
2) Mobile/Manufactured Homes not assessed as Real Property:phiStIle with thaCourttY AUditorof the county
Where.theproperty.lalocated during the twelve(12)months before Mardi 3f of each year tharteductiOn Is sought. • . •
ee reverse side fored0fiehaildefruCtione and qualifications
•6poliCaet termer or contract.buyer.,see restneeens on reverses/del.
Michael W../Lisa Apon*0y . . . .
Taxing Distelet Key number/legal description RecoZober Page number'
. . .. .Johnton 26-22-12-30070.02.061,024 , _ ,..,5..,..„
A.....„,u......,,,,opeity.„, • Mortgage!Centniet indebtedilees unpeld'es of Mortgage,/Contrail Indebtedness iihridirt•as of II:thaosppnearittheerne
assessment date.arrant year assessment dale,current year date of application• .....z-- legalti eMinable,owner?
•$188,000. El Yes 0 No ,
it rio,Whatittds/her exactsbare of interest? 1(Myriad With tionielene other then appetisei Indleate With WhOM
If nine on record is different.then that otapplICant Indicate belowt '( the•properly In-question:Annually Atiteeted.
0'13041;PTOPOftY,,111 T4%Attessed -
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Narrie otritertgagee ortordractseller -‘ ! ' ni
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-firstfederal Savings:Bank
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AOthetatiMongagesiar conned seller(numbetand street,dty,state,andZIP code). . •
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Name O(ossignee orether owner or holder at mortgage Le
-Address of.essignee(number end sheet:exly,stele;and ZIP cock) ...dis\,
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Does applicant own property In any II yes what county? What-Texing District? Has this deduction;been requested II,,.1-'.,.,,,,-,• -:;tot deduckn
other Bounty .t.:,... . .i, dri propertyfOr. ,-,;,,i.,.•, •'-, 1,1-.,. •f.0
Inindierie?: L.P(eS. 'LJNo current-year?.. 1,..1 YeS. .1-3 NCb w -
4;eartbitISobterititled 10 Mier:fedi/01On unless the person a balance bathe persons ritertgagafrOntr0.01100Arleselhatla.feCoAtect In the count),
recorder's affrtelinCluding•anYhernaettuityliniebt credit thefts.recorded Inthezeunly recorders bffiCe)thet la-,thebeilarcintiov000lio:
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COUNTY AUDITOR , . . . . • -
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peduinlen•approved In the amount of:
20 ' 20 . 26 20 20 20 20 ..
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Sigrtatu" d-CoUntyAudttor County /--, .• ..Date(ntordivday,year)
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11 (.. )/}it--f-k, J.(-Li . C7het-Cal ' I 2-03-
, - ' AL
and foregoing:information is true and carretLandlbat the:applicant:IS a resident of Indiana and
4:
..- .:.:i.l..Ciiaiefitotitract.)loyer of the afore Mentiotied'Prepertfo n'date application Is filed
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-i:111404,M0e,ti.40W07.062 '00,? 1,6
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Full rodent anciten0 of eppli t.(number and street,city,state,and ZIP code)
11754:S 150 W, Haubstadt, IN,47530 ._ . . . ......
Person authorized by duty executed Power of Attorney or by.IC 0-1.1-12-0.7 Dale(month,day.year)
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- -*Rim;of-authortzed person(numeerend taint,city,state,and ZIP code)
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The penalties for perjury can include Imprisonment up to:two and a half years and a fine not to exceedS10,000,
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RECEIPT FOR FOR FILINGSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS .... ‘.
.Narneoteppliaant Name.of mortgagee or contract-seller -
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MIChaelW,/Lisa A Conway First Federal•SaVings•Ban - 14,- '• P.'7' . •
...00totio4(month. yeas) Amount of Indebtedness 'Taxing.. ,i2--
$1.88,090 ,/- a i a os..,. tv•-/
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.,•,,,:f4;:1•.*;rr..1..4.110!;#4$1?fig.. ._.°" .
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.'.::':'.i.,•:....: 1::-.:,-264-2A2430404)0•2;061-024
.'•,;•:•:,.-!, 41go4uto- Corini4 •Ancitott County Recorder CountY• 1#fil:disk OM A\ \k> ock
:::A:PA/a_ ar'llt-X- i IC,i GIBSON /2-3-1,- 111- ,,,..., •
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