HomeMy WebLinkAboutMortgage_Clark (15) -*•:"'n• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- 1;), FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED Gibson P �Z g 2022
Ca q.., -1' State Form 43709(R14/1-20)
Prescribed by Department of Local Government Finance
JAN 0 5 2023 File Mark
INSTRUCTIONS: To be filed in person or by mail. For filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propert
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)
Austin T.Clark
Taxing District Key number/legal description Record number Page number
O 2 g 26-12-18-102-003.324-028 and 26-1-2-t0-102 000.5222-Q 0/ �O2 ����
Southside Add Pt Lot 8;
rSouthside Add Pt Lot 8
sed 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 a stable owner?
$144,400.00 $115,430.00 es 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 t property in question:Annually Assessed
FFILF,D Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
United Wholesale Mortgage, LLC ISAOA/ATIMA 3 Q 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP ccE C
P.O. Box 202028,Florence, SC 29502-2028
Name of assignee or other owner or holder of mortgage /7C
GIBsON UNTY AUDITO .
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deducts een requested If yes,state amount of deduction
other countyon property for yes ❑ No
Indiana? ❑Yes ❑ NO current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cot htt'9 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 20y
County Dat�(mh , )^ `�
Signature of County Auditor �t \�C� l`Ole `'0'G
ilvT'A�Id` 1 Gibson
I/We certify under penalty of perjury that t he a ove and foregoing information is true and correct and that the applicant is a resident of ndiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
104 E Kentucky Street, Princeton, IN 47670 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person(number and street,city,state,and ZIP code)