HomeMy WebLinkAboutMortgage_Clark (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
o„-,,,��,a County Township Year
7 ._: :::fi: - FOR DEDUCTION FROM ASSESSED VALUATION
t3z .:,: / State Form 43709(R13/10-15) qPrescribed by Depart ent of Local oovem ent FitT
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INSTRUCTIONS: �. _ 1 c
Y� File Mark
To be filed in person or by mail. Form fled with:
Filing Dates: 1) Real Property:Must be complete and dated in calenda for which the deduction is sought.
Must be filed or postmarked with the County Auditor or Coun ecorder of the county where the property is K-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)
Matthew C. Clark and Hallie J. Clark, husband and wife
Taxing District Key number/legal description Record num ber P e nber
Columbia 26-14-19-400-000.017-006 KJ(0 �I."]J�
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 application legal or equitable owner?
$105,500.00 IZI 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
Property ❑ Annually Assessed
Name of mortgagee or contract seller FIL Mobile Home(IC 6-1.1-7)
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZiP code) p E C 1 2020
101 N 4th St., Evansville, IN 47708
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city state,and ZiP code) tp
GIBSON
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti een requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes El No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o co fact 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 1:�\ J3 County K. Date(igo`If/,clay,yew .
I/We certify under the penalty of perju -- e above and foregoing information is t nd correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature( wner's full name) Date(month,day,year)
'q 10/14/2020
Full resident address of applicant(number and strel ity state,and ZIP code
12021 E 200 S, Oakland City, IN 47660
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)
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