HomeMy WebLinkAboutMortgage_Shoultz (3) 1ER,%3a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION
al"')3•, ,r: . State Form 43709(R14/1-20) Gibson Gson 2021
�= Prescribed by Department of Local Government Finance
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INSTRUCTIONS: To be filed in person or by mail. sfi 1 e/Patti/Bway T 3/5/2021 File Mark
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. WI 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. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jarrod A. Shoultz and Sonia Rachelle Shoultz, husband and wife
Taxing District Key number/legal description Record number Page nu ber
Oakland City 26-14-18-102-000.495-007 ->0 2` 1 I L, ,
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?
. $71,200.00 123 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
VI Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union F I LED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4401 Theater Drive, Evansville, IN 47715 Mar 05 2021
Name of assignee or other owner or holder of mortgage
ear a sited
Address of assignee(number and street,city,state,and ZIP code) GItiSON COt7N I Y At7DITOR GB
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ®No current year? )(Yes 0 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
CB
Signature of County Auditor County Date(month,day,year)
�j�Coma1 3/5/2021
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name Date(month,day,year)
Ja4.4.41 A c S 5--Awi-----
03/05/2021
Full resident address of applica t umber and street,city,state,and ZIP code)
830 Highland Ave., akland 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Jarrod A. Shoultz and Sonia Rachelle Shoultz Evansville Teachers Federal Credit Union
Date 3�Impnf5/2e,2day,year) Amount of indebtedness Taxing District
11 $71,200.00 FILE Oakland City
Key number!legal description
26-14-18-102-000.495-007 CB Mar 05 2021
Signature of County Auditor/County Recorder / County /� Date(month,day,year)
�a ,tke&, l G'sof�jp,,� a i s 3/5/2021
GIBSON COUNTY AUDITOR CB