HomeMy WebLinkAboutMortgage_Jackson (7) Fn4k STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
° �.y FOR DEDUCTION FROM ASSESSED VALUATION
„`,.4:-: Ijp State Form 43709(R12/6-14) RECEIVED Gibson -f� 2021
` -"'' " Prescribed by Department of Local Government Finance
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INSTRUCTIONS: CaUP11\9).
CA �j'* SEP 1 8 2019 File Mark
To be filed in person or by mail. 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 County Auditor 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)
Daniel Jackson and Mackenzie Smith
Taxing District Key number/legal description Record number Page number
028 26-12-07-401-003.132-028/Old Plan 24 Pt, Gibson County a(j- o Oo® 0 Llo y 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of T Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
coo L-no t 0 Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If.name.on recordis_different_than_that_of_applicant,_indicate below: __ _ Is the property in question:Annually Assessed_ _
❑✓ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
'Plaza Home Mortgage, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) .i
6420 Sequence Drive, Ste 200, San Diego, CA 92121 FIL Fil
111)
Name of assignee or other owner or holder of mortgage SEP 2 1 1020
Address of assignee(number and street,city,state,and ZIP code) /) i .
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Does applicant own property in any If yes,what county? What Taxing District? Has this gtltfCtidrS'tJek9e��]�sted A Tf�es s"ti%amount of deduction
other county on property for
in Indiana? Yes o current year?El ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or 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 20
Signature of County Auditor County I Date(mon ,da year)
)A 1.1 )\11\ 62...0
I/We certify under the penalty of perjury that the above and foregoing information is tr�and correct and that the applicant is res ent of Indiana and
. _..__owner I contract-buyer of the aforementioned property on date application is filed. _ _ _ _ _ _ _
Sture(owners full name) � Date(month,day,year) _ \
Full resident ad ress of applicant(number and street,city,state,and ZIP code) U
101 South Gibson Street, Princeton, IN 47670
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 d Name of mortga a or contract seller
G.v\.k \ S o, ci- yo a c ii s'ii y\�20�
Date filed onth,day,year) Amount of indebtedness Taxing District C, xi
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CA - 21' � �. �a , y— oat -13 Key number/legal description r t-Q �'°
`),� _ .a--p1 °�C�\ - ej3 11)9-0O t 20Zp y 4( , CO .
Signature of Co ty uditor I ou e er County \ Date( onth,day,year) c=3 I'in
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