HomeMy WebLinkAboutMortgage_Hoffman ""' l• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
' f State Form 43709(R13/10-15) Gibson Patoka 2019
• Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ❑ County Auditor
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the ❑ County Recorder
property is located on or before January 5 of the immediately succeeding calendar year.
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)
William C. Hoffman , Alexandra L. Hoffman
Taxing District Key number
legal description R rlusbpr� Page number
Patoka 26-12-08-204-000.748 028 (l/� (� tL7C)
Acsecsed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpai as of Is apple nt the sue
assessment date,current year assessment date,current year date of application I or equitable owner?
132,050.00 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: ee p ❑tion: yA Annually Assessed
Mobile
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank MAY 2 2019
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
PO Box 918, Evansville, IN 47706
Name of assignee or other owner or holder of mortgage
C,IRSON COUNTY AUDITOR -
Address of assignee(number and street,city,state,and ZIP code)
Dees applicant own property in y 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 ❑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 recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 s cal 20 20 1 20 20 20 20
•
Signature of C editor 0 County Date(month,day,year)
1\1114\thW:71
I/We certify unde the penalt erjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on dat�pplication is filed.
Signatur owners II nam � � ;D Date(month,day,year)
4,, • �`�",,,, ^' oaizsn9
Full resi ent ad s of applican u er and street,city,state,and ZIP code)
2108 Taylor Ave, 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 perjury can include imprisonment up to two and a half years and a fine not to exceed S/0,000.