HomeMy WebLinkAboutMortgage_Clark (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co. Township Year
_i : FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) 44�`( `;' 2018
• -, Prescribed by Department of Local Government Finance �j q '
INSTRUCTIONS: b File Mark
To be filed in person or by mail. �"ppop b �-p11 Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the dedyaion is sought.
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where th-p � .' is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ;• ❑ Cotm Recorder
2) 'Mobile/Manufactured Homes not assessed as Real Property Must file with the Cou • •, •04-- dflQ�R h
where the property is located during the twelve(12)months before March 31 of each 1.i•4.t• •onn is sought.
See reverse side for additional instructions and qualifications. oBSQN
Applicant(owner or contract buyer-see restrictions on reverse side)
Benjamin 0. Clark
Taxing District Key number/legal description I e nu7lber Page number
26-11-12-103-002.164-028/Tower Hgts. Lot 223 and Pt. Lot 222 L 5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
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
IN Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Ruoff Mortgage Company •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1700 Magnavox Way Ste. 220 Fort Wayne, IN 46804
Name of 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 If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for 3000.00
in Indiana? ❑Yes ❑No • current year? O Yes ❑uo
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 r 20 20 20 20
Signature of County Auditor County Date(month,day year)
I 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 filed.
Signature(owners full name) Date(month,day,year)
4/3/2017
Full resident address of applicant(number and street city,state,and ZIP code)
2011 Glenwood Drive, Princeton, IN 47670
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 S10,000.