HomeMy WebLinkAboutMortgage_Hirsch (3)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
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4' ,,,, Pr�aibetl by DepartmeM of L.afal GovemmeM Fnance -
de
�srRUCnoNS:
io be filed in person w by mail with the CountyAuddor or Counry Recorder of Ne oounty where the property is located. O �
Fifirg Dates: i) Real Pmperty: Must file durnig the year /or which the deducfan is sough[.
2J Mobde / Manufadured Homes not assessed as Real Pmperty Must fiie dunng the tweNe (12J monfhs C�:
6efore Marcfr 31 ot each year the deductlon is sought.
See reverse side 70� additional instnrctions and quali�cations. G IBSON C
npp�cay (owner orconhacf 6uyer - see resbirb"ons m iaverse side)
Counry Auditnr
2�unN Recorder
Disbict Key rnimher / legal deur�tion Recofd rwmber Page numba
� a�a- _ -�-o�{-ooL .3y�-o�� o�r �
e0 vah�e d rn�d pioperty as d A1rn(qa ge / Contract irdebtedrress unPaid as W Mongage I Contrad'vMebteAnest unpaid az d h Me aG�t Me sde
7, am�nt yrar Mamh 1, a�rtent year � Oate o( appGCatim legal w equitade ovmeR
ai�59� ❑Yes ❑No
If ro, what a his I Mr e� share o( interest?
It name m iemrE is dMe2nt than ihat of aDpfrant, c�A¢
Name ot rtart9a9ce or mntract sener
�
Mtlress of mort�agce w contrad se9er (n�and
Name of asvcpiee w oU�er owner w halder of mortgage
Ad7ress assi�ce(num6erarMSVeet�:sfate,antl
Oces applicant wm G�P¢nY in any alhtt
minuy fo ��aw,a?
❑ Yes ❑ No
�
Detlucum apprwed in Me amoum of:
�
Signanne N Co�mty Auartor
tiry, state, a� ZIP cade)
tt awned wiN sameone otMs tl�an spouse. indmate with wlwm
IS CIC QfOpERY T QUCSGOfI: Mf1U20y PSSPSSlb
�eal Property ❑ Armuany 0.ssessed
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�e� Dra���er i\i0. �o //_
DO � ... ...
. �i �,�y.> vmai rap�y oau+aa . . . • ..
C�!'v 1�'�. ....�0 7� ..
COUNTY AUDROR � � "'
20 - � 20 � 20 -
Caunry
20
rS� ��
D'ate (rtnaRh, daY. N��
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I/ We certify under the'penalry of perjur7�hat the abov� foregoing infortnalion is We and correcl arid ihat ihe applinnt is a resident of Indana aM
owner / mntracl buyer of ihe atoremengoneE property date application is filed.
Sig�ture (owrierS fiA me) • Data (rmYh. deY.Y��
� � �•
Full re4den( aGtlres of appGmnt (numGer street �: stafe, antl ZIP )
5a � �s �
Persm auNaaed Gy EWy executetl Power oflWomeY a q' IC Ft.t-12-0 7 Date (rrronfh. dey, Ma�
AEdress o( autlmm.�d persn� (numOer aM sbeet tlry, state. anC ZlPcade) .