HomeMy WebLinkAboutMortgage_Hopper ' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Let)
FOR DEDUCTION FROM ASSESSED VALUATION Gibson 0 2 2022
State Form 43709(R14/1-20) RECEIVED
Prescribed by Department of Local Govern ent Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. '/A-4 v 1 1-41c DEC 1 5 7022 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 0 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property County Recorder
is located on or before January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Christopher Hopper and Nicole Hopper
Taxing District Key number/legal description Record number Page number
Fort Branch 26-18-13-402-000.153-026/DOUGLAS ADD 20 2--CD2__ 5 215^
I Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage
/Contract
indebtedness unpaid as of Is the applicuant
tee sole
assessment date,currentdate of application year assessment date,current year �es 0 No
$0.00 $132,554.00
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
VC) s e property in question:Annually Assessed
If name on record is different than that of applicant,indicate below:
Real Property ❑Annually Assessed
VliSh'-\.°)
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Ort�
German American Bank t 6`t 1.
Address of mortgagee or contract seller(number and street,city,state,and Zip d . ,�L�.�,,,�,00..
PO Box 360,Jasper, IN 47547-0360 V."�' 'tAv.O`
Name of assignee or other owner or holder of mortgage aj�� PVO
Address of assignee(number and street,city,state,and ZIP code)
�.�,1 ,t.A .`N
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio en requested If yes,state amount of deduction
other county on property for Yes El No
in Indiana? 0 Yes ❑ No current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ont ct 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
County Date(m of,d year)
Signature of County Audi �r Il,!)- .O 7 R_
,`(mil Gibson,'1�tnv Gibson
1/We certify under penalty of perjury tha above and foregoing information is true and correct and that the applicant is a rest ent of ndiana and
ner/contrSacct buyer of the aforementioned property on date application Is fled. pa�er( nt/y,da ryap)_
gnature�.r.9-6 ll namelies rzed T/ F f ���,—`\y
Full resident address of applicant(number and street,city,state,and ZIP code)
104 E John Street, Fort Branch, IN 47648 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person(number and street,city,state,and ZIP code)