HomeMy WebLinkAboutMortgage_Clark (9) `Mr 0 STAY,
. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i:' „* FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) RECEIVED Gibson Owensville 2022
Prescribed by Department of Local Government Finance
T- FEB 1 2022File Mark
INSTRUCTIONS: To be filed in person or by mail. KQ y►'Q 1 0 2�
Ijp�t o filed with:
Filing Date: Form must be completed and dated in the ca dar year for which the deduction is sought,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope County Auditor
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Richard Eugene Clark and Stephanie Clark
Taxing District Key number/legal description Record number Page number
Owensville 26-18-06-303-000.728-022/Lt 5 Rock Road Estates .2/0 22 5:;:'Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the s•e
assessment date,current year assessment date,current year date of application legs�or itable owner?
$118,400.00 $225,000.00 Yes 0 No
If no,what is his/her exact share of interest? FIf owned with someone other than spouse,indicate with whomIf name on record is different than that of applicant,indicate below: T -----�F ��/ th property in question:Annually Assessed
I. ` Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 1 Z022
Mortgage Masters of Indiana, Inc., ISAOA FEBf U
Address of mortgagee or contract seller(number and street,city,state,an P code)
501 N.Cross Pointe Blvd, Evansville, IN 47715 /teta( G2. . �f�. +,rim
Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city,state,and ZIP code) GIBBON COUNTY AUDITOR
.Does applicant own property in any If yes,what county? What Taxing District? I Has this deduction en requested If yes,state amount of deduction
other county oproperty
or Yes ❑ No Yes 0 No Indiana? current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cont ct 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 Auditor4..1.1
- (, /0 :4.\* County Date( gnth, a
1\.1MV'JS`-'�l GibsonI o ..Z-
I/We certify under penal jury that the above nd foregoing information is true and correct and that the applicant is a re dent olalciy
Indiana and
owner/contract b orementioned property on date application i le
Signature(owner' II a Dat ( nth, ay,year).
Full re ' t address of applicant er and street,city,state,and code)
1 ��7
20 Rock Road,Owensville, IN 47665
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)