HomeMy WebLinkAboutMortgage_Clark (14) Q.MF;e*F�„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
° 41- FOR DEDUCTION FROM ASSESSED VALUATION
" 1%- g State Form 43709(R12/6-14) Gibson Peteka 2020
,w Prescribed by Department of Local Government Finance RECEIVED
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INSTRUCTIONS: \ File Mark
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To be filed in person or by mail. � Iv�u 9 2020 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is ❑✓ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 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.
Applicant(owner or contract buyer-see restrictions on reverse side)
Benjamin O. Clark and Mary V. Clark
Taxing District Key number/legal description Record(��6 number Page number
028 26-11-12-103-002.164-028/TOWER HGTS 222PT/223, Gibson County 0�'+f/U,� rye
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/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?
I. 1 —1 `� 0 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 El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller t� - „
Evansville Teachers Federal Credit Union ILF Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ° -
4405 Theater Drive, Evansville, IN 47716
Name of assignee or other owner or holder of mortgage NOV 12 in
Address of assignee(number and street,city,state,and ZIP code) �V r n
Does applicant own property'r any If yes,what county? What Taxing District? Has this ®or ar CIAOLfed I slfi¢eg,°sIdtb`amount of deduction
other county �_ on prope
in Indiana? ❑Yes i • current year? FA Yes ❑No
A person is not entitl-i to this deduction unless the person has a balance on the person's mortgage. 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
Signature of County Auditor County 1 Date(mo th,day,��Vear)
W11 5011 \\ V2 ')q`LO,
I I We certify under the penalty of perjury that ti'ie ove and foregoing information is tru td correct and that the applicant is resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. _
7natre
ner's3ull ha e) Date(month,day,year)
l 0 - a 3-DnCT)
Full resident a dress o app scant number and street,city,state,and ZIP code)
2011 Gle od Drive, Princeton, IN 47610
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name_of applicant Name of mortgagee or contract seller
V,�is nA 14 a 1- Oa V �C&(( ,� a
Date filed(math,day,year v Amount of indebtedness [ . i,T ' g `'1 ct
•12• I3'-1 , 5
Key number/legal description 1 2 2020 ��_ / n
',0-1 (.- f -1O5-0 d( 4-b - NOVY
Signature of Coun r/County Re d County \ Date(month,day,year)
mi}`f\ A► Li kr N2. to.
GIBSO OUNTY AUDITOR