HomeMy WebLinkAboutMortgage_Hoffman (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
zi.t, FOR DEDUCTION FROM ASSESSED VALUATION �� n� ip Year
2.1. JX State Form 43709 R12/6-14) grSL/ 'Pe oka 2016
Prescr ibed by Department of local Government Finance
INSTRUCI7ONS: FEB 1 NII6Mark
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 soug .
Must be filed or postmarked with the County Auditor or County Recorder of the county where the i County Auditor
located on or before January 5 of the immediately succeeding calendar year. aST _County
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County u i?o /t rggAIy Y A U1411:1-op
Recorder
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)
Jennifer Lynn Hoffman and Douglas Keith Hoffman
Taxing District Key number l legal description Record number Page number
Patoka 26-12-06-100-001.276-027 a 0 t Cr --&S 4
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year Mardi 1,current year date of application legal or equitable owner?
184,900 168,000 p 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
Western Federal Credit Union IZI Real Property ❑ AnnilallAsessCG1.1-7)
Name of mortgagee or contract seller
1899 Western Way, Torrance, CA 90501
Address of mortgagee or contract seller(number and street.city,state,end ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own propertyinny 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 El 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 Date(month,day,year)
I 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 p on date application is filed.
ignatu (o n e) Date(month,day,year)
pit k W �r, -n t Fill resident address of applicant(nun, er and street.city,state,and ZIP
1259 N. Main St. Princeton, IN 47670
Person authorized by duty 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 hvo and a half years and a fine not to exceed 310,000.