HomeMy WebLinkAboutMortgage_Clark (12) o• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coo L Townshiq Year
O FOR DEDUCTION FROM ASSESSED VALUATION
i.- • State Form 43709(R11/6-09) GIBS INCEN 2017
Prescribed by Department of Local Government Finance
INST4pCTIONS: s
File Mark
To be filed in person or by mail. arm •:w11 :
Filing pates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought Co t a -.tor
Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. I,.,• t
9/'7T.T r.ty Recorder
2) Mobile/Manu/actured Homes not assessed as Real Property:Must file with the County Auditor gEyR
county where the property is located during the twelve(12)months before March 31 of each yearrttheSON • It •
deduction is sought
See reverse side for additional instructions and qualifications.
Applic4nt(owner or contract buyer-see restrictions on reverse side)
ROLLIE C.CLARK&CATHY.CLARK
Taxing-District Key number l legal destdpdon Record number Page number
PRJNCETON 26-12-08-400-00.423-028 ao V'i— `31-k
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 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?
495Q0.00 68400.00 50000.00 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If namy on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name Of mortgagee or contract seller
FI9 T NATIONAL BANK OF CARMI
Address of mortgagee or contract seer(number and street,city,state,and ZIP code)
20) E. MAIN STREET,CARMI, IL 62821
Name pf assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
•
Does Applicant own property in any other If yes,what county? -What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduc(lon approved in the amount of:
IT 20 20 20 20 20 20
Signa(yre of County Auditor County Date(month,day,year)
I/WMe 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 I contract buyer of the aforementioned property on date application is filed.
Si at)r w /s full name) Date(month,day,year)
( p4i C� CQ i �7�r
Full'elid(re((ddress of applicant(number and street,city,state,and ZIP code)
Person authorized by duty executed Power of Anomey 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)