HomeMy WebLinkAboutMortgage_McClafflin 0-07 ,4 , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r FOR DEDUCTION FROM ASSESSED VALUATION
°'- fr: .tJ1 State Form 43709(R14/1-20) Gibson Washington 2020
'ale
:-..0 Prescribed by Department c 0 c—v 3 7
File Mark
INSTRUCTIONS: To be filed in person c
Form filed with:
Filing Date: Form must be completed Drawer NO )ught.
® County Auditor
Must be filed or postman • y where the property is
located on or before Jam rst due and payable. ❑ County Recorder
Card NO.
See reverse side for additional instruction;
Applicant(owner or contract buyer-see restrictions on reverse side)
Steve & Jackie McClafflin
Taxing District Key number/legal description Record number ' Page number
Washington 26-05-57-094-000.516-017 D0 aO L{ol9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of anplication �� legal or equitable owner?
$ ,I("1_l Il r� I
L. 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
®Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Ste.,._.,,e a. st �, ((( ��� _ cl- - -" .,;'
Addres of mortgagee ntract seller(number and streej�City,sta e,and ZIP code) l
vv
Name of assignee or other owner or holder of mortgage '\fr\lA\ 151
Address of assignee(number and street,city,state,and ZIP code) _` V O\CO(Z
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been req .te eest8te amount of deduction
other county on property for r\
in Indiana? ['Yes IZINo current year? ®Yes ��
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract; CAdness 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 6 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)
,Lv ,_._ L,,,,,,I./,,, Gibson 11/12/2020
1/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.
Si a ure(owner's full name)13Date(month,day,year)
. % n
Full resident address of applicant(number nd street,city,state,and ZIP code)
7710 N. Shiloh Church Rd, Hazelton, IN 47640
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.