HomeMy WebLinkAboutMortgage_MacKay (2) rM, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County TownshipYear
f ;- FOR DEDUCTION FROM ASSESSED VALUATION
t '- State Form 43709(R13/10-15) RECEIVED ((''�� (3 p1
,.'`�;.-_,''l Prescribed by Department of Local Gove m nt Finance �'\`�� 2�
INSTRUCTIONS: , \ ( JAN 0 3 2022 J File Mark
To be filed in person or by mail. \\\\ Form filed with:
Filing Dates: 1) Real Property:Must be completed and datIS".611_,
the calendar year for which the deduction is sought.
Must be filed or postmarked with the Countditor or County Recorder of the county where the property is viN 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)
MacKay,Christopher M and Jennifer L
Taxingber
Pato District a t VD� - Key number/leoal26-12 15-100-001.391-027/PT NW 15 2 10 4.92 AC C-1 Recordption 2,‘
,�r Page� ?G
Assessed value of real propert 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?
112900.00 75555.00 80.000.00 x 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
FILE T x Real Property Els Annually Assessed
Mobile Nome 6-1.1-7)
Name of mortgagee or contract seller
Regions Bank d/b/a Regions Mortgage ISAOA Address of mortgagee or contract seller(number and street.city.state,and ZIP code) JAN 0 5 2022
2050 Parkway Office Circle-Rirmineham.At 35244 ,, )
Name of assignee or other owner or holder of mortgage / thwal `fir. i ,..,r.6
GIBSON COUNTY AUDITOR
Address of assignee(number and street.city,state.and ZIP code)
Does applicant own property)n any If yes,what county? What Taxing District? Has this deducti requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes o current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o 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 offi )the ' the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Audit C,� County Date( nth y.year)
I i We certify under the penalty of perjury that the ye and foregoing information is e and correct and that the applican is a resident of Indiana and
owner� I c..- er of the afor entioned property on date application is filed.
i. = i;,- % Date(month,day.year)
9R. ., fifi ,./.. jai
Full r� - of a nt mber and street,city.state,and ZIP code)
2834 Too Hat Rd.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 penury can include imprisonment up to two and a half years and a fine not to exceed S10.000.