HomeMy WebLinkAboutMortgage_Hoffman (5) d//;°a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
/.ai FOR DEDUCTION FROM ASSESSED VALUATION
\.�.� State Form 43709(R11/6-09)
\,e„'• Prescribed by Department of Local Government Finance F I LED
INSTRUCTIONS:
To be filed in person or by mail. F mC fitly
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. APR i ej—��
Must be filed with the County Auditor or County Recorder of the county where the property is located LLLJJJ County Auditor
on or before January 5 of the immediately succeeding calendar year. ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the l/l
county where the property is located during the twelve(12)months before March 31 of each year the X171
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jacob M.Hoffman
Taxing District Key number/legal description Record number Page put b
Fort Branch Town 26-18-13-402-000.863-026 c"(1 (J_7 t.-1'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
584,832.00 al Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below. Is the properly in question:Annually Assessed
S Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bancorp
Address of mortgagee or contract seller(number and street,city state.and ZIP code)
PO Box 360,Jasper. IN 47547
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ yes 1 No ❑ Yes GI No
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/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 off the aforementioned properly on date application is filed.
Sig lure(owners lull name) '`- Date(month,day,year)
X P7 L 4-i(-16
II resident address of applicant(number and street.city.state.and ZIP code)
103 East Park Street, Fort Branch.IN 47648
Person authorized by duly executed Power of Attorney or by IC 6-L1-12-0.7 Date(month,day.year)
Address of authorized person (number and street.city state.and ZIP code)