HomeMy WebLinkAboutMortgage_Hirsch (2)R`n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
,___,_ : FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 43709 (R77 / 6-09) �
�' ,.,. � PresaibeE Oy OepaRmem of Loral Gwemment Firence
�STRUCTIONS: -
To be filed in person w 6y mail wifh the CowtyAuditor or Counry Recorder of Ne counry whefe the prope I fed.
Filmg Dates: 1 J Real Pmperty: Must file durirrg the year (o� which Ihe deduction is sought �� 7 2 Q��
2) MobBe / Manufactured Homes rrot assessed as Real Property: Mus[ Ae during the hveFve (1� monfhs
6efae Ma�ch 31 of each year fhe deduction is soughG C��
See reverse side !or additional instructions aiM qualificatrons. �-
Appfrar�f (owneror�oriMdc buyer - see resbicbons m reverse vtle) •
ii �. , � , � � ,--� � GIBSON COUNTY ALl[
Year
Mark
� CountyAudrtar
❑ Counry Remrder
Tavng �istrict Key rqun6er / legal desaiplion R¢pprd nump¢r Page nurt�Ca
a� - - �y- �oa-000•�89-oa� i S�ab
AssesseC raNe �d real qoper,y a N Mortgage / Contraa'vdehtedness unpaiC as of Abngage / Con�ct'vWeMedriess un7aid as d k Me eP�f ihe wk
MarU i� aarmt year MarC� t. a�m �, Eate of aPP��' 1 i D U� D �a� 0 vese �
111a. what is his ! her exact share o/ interest? If ovmeE xiM sorneone other ihan spousa, iMicate with whom
II name m recprC ig Qrtf¢r¢nt lhan Nat of apptirant, mdirate bebw: Is the property in v�: %�nualyASSessed
C�� �m ❑ ;:"_";,�"�:_� . . -.
Nartre of rtrortgagee or mntract seller y�/�
AtlEress oi rtqrtgagce n contrad u0er (n�ber and sbee4 clry. s+ate, ard ZIP coda)
00¢s applifanl ovm
munry in Indiana?
appfoveC in Ne amwnt
No
[IN cotle)
9s Pr
If yes, whal count/� What iaArg o5u
COUNTY Al1DROR
20 20 20 20 2
SignaNre W CounryAUdi�or Counry
C-
I/ We certi(y under the penalry of pe � that Ihe ve and foregoing informafion is true arn
ovmer / mntraq buyer of the a(oremen0oned pro rty on date appliration is filed.
Signawre (o�me/s hNnama) , �
Full revdent addres o�9pplinnt (number aM street riry, stare, and LP ootle)
/oa F_. o�9lC F� ivLa�-,cb���✓
a
person (number arM snee4 cily. sfafe, aM ZIP m0e)
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