HomeMy WebLinkAboutMortgage_Clark (6) ,,,,C.._41;;;;„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4.4 .4
r1 FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/6-14) 2016
'�-_ Prescribed by Department of Local Government Finance File Mark
n. � 1
INSTRUCTIONS: IR��
To be filled in person or by mail. ' vTithr
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 1L'
Must be filed or postmarked with the County Auditor or.County Recorder of the county where the S EP 19cdt6y Auditor
property is located on or before January 5 of the immediately succeeding calendar year
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ❑ County Recorder
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. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Mike Clark and Jana Clark
Taxi,.'Iist•a Key number/legal description 26-23-16-200-002.481-024/1679 E Lincoln Record number Page number
/_�� j Pass, Haubstadt, Indiana 47639 147-389 1
C e sed value of real property is of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
`arch 1,current year March 1,current year date of application legal or equitable owner?
$100,000.00 O Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question: Annually Assessed
O Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville leathers Federal Credit Union
Address of mortgagee or contract seller(number and street.city, state,and ZIP code)
4401 Theatre Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address 4,-Z ?hit- ?
Address of assignee(number and street city, state, and ZIP code) )a i/i : "\ ,,,cd �[.c-/ K r J
Does applicant own property in any If yes,what county? at Taxing District? Has this deduction been re uested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes 0 No current year? ❑ Yes O No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property$ date application is riled.
Sjghature(owner's toll na e) /1/) — Date(morW>\ga/��
Fl`f�T rl4.r_ l`., / C'/r./ l I
ull esident address of applicant(number and street,city, state(arJd ZIP code)
1679 E Lincoln Pass, 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.