HomeMy WebLinkAboutMortgage_Hirsch (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip v
, FOR DEDUCTION FROM ASSESSED VALUATION
• _ . �� Sfate Fortn 43709 (R11 / 609)
,,,,. f Presaibetl by DepartmeM of Local Govemmer�t Firence
wsrRUCnoNS:
F'� 'LOtU
Form filed wiih:
b 6e filed in person or by maii wifh �e Counry Auditor w Caunry Recorder o( the counry where fhe property is located.
FiArg Dafes: 1) Real Property Must fde durirg the year for whirh Ihe deduction is soughG unty�y�
2) Mobde / Manuladured Homes not assessed as Real Prt�peRy: Must file during the twe�ve (12J months .� i� 73�
before March 31 o/each year the deducROn is swght �d^b R��
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See reverse side (or addrtionef ins7ruUions arM qualficafions. '
Mc�� (owner or buy� - seo resui�sa�s q�jBvarse siie) 1 � � �
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It m. what b his 1 her eu� share W interxY?
tt rwne m recw0 a SMerent than Nat ot aPP��. 6Wica[e 6ebw
rontrxt se0er
��i�.'�._�`. L'. �1�rT.1
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rvarne m assgncre w aw rnmer a ndaa ar nvrq�apa
Pdtlfass ot a5signee (n �� �n �J/ n� i/ �C.% K
l�r� �j�
oces eaP�m o.m w �j /
munry in IMana? v{ D/� _�/��
Fii
signacure
2o I 2o I 20
339-Da6 I `�°" n
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rc aw,ee witl, sanew» omer ihan spouse� inaimte witl, Mian
y?� y
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Yes ❑ No
Is Cre P�GQnY in QuesCOn: MnueOy Assused
❑ Real Proaertv ❑ %vuivalir Assessed
Tavtg District7 I Nas Nis tli
far arrent
zo— � 20—
oa� prpmn. dar r�d
� P��Y
❑ No
2(1 _
1/ We cerOfy under Ne penalty of perjury that the above and foregoing intomiation is true and cortec[ and ihat ihe applirant is a resident of IMiana aM
o.mer I can bu f the aforementioned Property on date appfiqtion is filed. ..
3 ) � J ' Date (�W, daY• Y8�
i
or by IC 61.1-12-0]
Pcrson (numberaN sbeeR d�: sfafe.
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