HomeMy WebLinkAboutMortgage_McClanahan •
Q; —4-sue STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _County Township Year
oq >. " FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R14/1-20) R EC,E V 1,,9 E Gibson 0 2
'age"' Prescribed by Department of Local Government Finance
FEB n ? ?� File Mark
INSTRUCTIONS: To be filed in person or by mail. r-� C'e 1 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. [Z County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Andrew McClanahan and Tom L.Wallace
Taxing District Key number/legal description Record number Page
e number
Fort Branch 26-18-24-201-000.205-026/PT NE 24-3-11 .48 AC 7-Z1 c.� 3
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?
$0.00 $138,500.00 Q Yes 0 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- - -
,M1 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Yr__ - i -"'�.`
Ruoff Mortgage a e Company, Inc.
P Y.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ® 3 r CV1 -
1700 Magnavox Way, Suite 220, Fort Wayne, IN 46804 _
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and street,city,state,and ZIP code) Q�f�'k" COUttI
GIBS®'
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu ion be n request If yes,state amount of deduction
other county El on property for
in Indiana? Q No current year? Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or act 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 Auditor in • \ County Da a(' th,day,yea) _
' l / Gibson a r r� 6egil)
I/We certifyunder penaltyof perjurythat the ab� 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 ap lic 1Ion is filed.• ( �p na re vets f/ @� > v V tA� D A(IY n ty,2021
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ull siden ddress of applicant(number and street,city,state,and ZIP code)
13 W. Red Bank Rd., Fort Branch, IN 47648
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 sell
Andrew McClanahan and Tom L.Wallace Ruoff Mortgage e il •an I c
Date filed(mon h,d ye Amount of indebtedness Ta ng_pistri —r'1 73
� Z1 $138,500.00 . 1�ort Branch co 3
Key number/legal description C o ri.
26-18-24-201-000.205-026/PT NE 24-3-11 .48 AC ... . C C C; ,' J ` ' -
Signature of Cour Audit Cou t Recorde County D-te ontp,�day,year)Iv L.
ir J! milli^�
r Gibson
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