HomeMy WebLinkAboutMortgage_Hoffman (2) 4NE- �P�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
°`' � '.%« FOR DEDUCTION FROM ASSESSED VALUATION
"t\w:. ';`. ;. ' State Form 43709(R14/1-20) Gibson Patoka Township 2021
° r916rcv1i' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be Ned in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. lZ 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 due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Rachel Hoffman
Taxing District Key number/legal description Record number Page number
Patoka Township 26-11-15-202-004.740-027 `20 2 100 Li,
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 date of application legal or equitable owner?
$ 175,644.00 11Yes ❑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
®Real Property_i I Annually Assessed
ED
31.1-7)
Name of mortgagee or contract seller _f,
German American Bank .---
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Fie ' `�
; 6 2021
Name of assignee or other owner or holder of mortgage fCt:
GiQSON Co ��,
Address of assignee(number and street,city,state,and ZIP code) UAiT 1
Y,gViif ;,�.rOi i •
•
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested I O
other county on property for ®Yes ❑No 4
in Indiana? ❑Yes ®No current year? O
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedn Cj 4 my
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis f i 'd
COUNTY AUDITOR
Cl L,
1 c1
Deduction approved in the amount of: Q U
20 20 20 20 20 20, —
Signature of County Auditor County Date tmonrn,Gay,year)
1 _,\,A_ \,, C5-- , I1,- ,J Gibson 02/26/2021
I/We certify under the penalty of perjury that the -,,.ve and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/con -ct buyer of the for, entioned p s4erty on date application is filed.
Signature(o le, full m Date(month,day,year)
' ,,/,.21(7C7i
Full esi;- t ress of appli ant number and reef,city,state,and ZIP code)
25.%. W Susan Dr., Princeto
Person authorized by duly executed Power.f 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)
Tha novaltiac fnr narinni ran inrinrla imnricnnmant tin to twn and a half vears and a fine not to eyreed S 10.000.