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HomeMy WebLinkAboutMortgage_Jackson (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 711. ''' FOR DEDUCTION FROM ASSESSED VALUATION ,4 h y IZOZ i t a�n Gson 009 2021 ,, i1 i r Stale Form 43709(R14/1-20) t 1 \..'a' Prescribed by Department of Local Government Finance i l . File Mark INSTRUCTIONS: To be feted in person or by mall.. Form filed with: Filing Date: Form must be completed and dated in the calendar year for which the deduction Is sought. Ri 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 duo and payable. ❑ County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse sfde) Jackson, Shannon H Taxing District Key number/legal description Record number Pa n 009 26-18-36-400-000.871-009 `ZU Z.2— . b 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 dale of application legal or equitable owner? 200,000 ®Yes 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 the property In question:Annually Assessed FILED ®Real Property ❑Annuobile allyHome(IC Assessed M 6-1.1-7) Name of mortgagee or contract seller US Bank Address of mortgagee or contract seller(number end street,city,state,end ZIP coda) FEB 2 3 2022 Name of assignee or other owner or holder of mortgage ,y22 Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUUI I CA( Does applicant own property In any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction othon perty for ;In Indiana?y ❑Yes 0 No current year? oyes 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 t Signature of County Auditor in\,... 6ry\I�..r �-„ County ©�` Date ar Ut eyYgga d ^�r"l I/We certify under the penalty of perjury that the above oregoing Information Is e nd correct and that the applicant' is4a residentn pf Indiana and owner/contract buyer of the aforementioned property on date application Is filed. i Signet oar's full name) Date(month,day,year) - --- /02 - 7 — ull resident address of applicant mbar and street,city,state,and ZIP code) 908 W Elm St, Haub, IN 47639 Person authorized by duly e' - - Q�,�4,�, Date(month,day,year) Shannon Jackson-$ 00;i700-US^�Bank—12/07/2021 Address of authorized persc ,-1 '1 ,r,.(� Jr'•.T- 1 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 Name of mortgagee or contract seller Jackson, Sha`nnan H cr- Dale filed(mgW(i,,,gtayf year) Amount of indeFei ' Taxing District _ r '4/ Jt Y�- Uri) J Key number/legal d4criptfon FEB2 3 2022\ r-�2„Z.," g \I.... 1� 26-18-36-400-000.871-009 2, J } Signature of County Auditor/ my Recorder County Date mo,N day r) 2:-{ GIBSON COUNTY A OR