HomeMy WebLinkAboutMortgage_Kirsch"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, � FOR DEDUCTION FROM ASSESSED VALUATION
• Stace Fortn 43709 (R77 / 6-09)
S,�,. � Presaibed by Departmen� of Local GovemmeM Fuance
INSTRUCT10N5: T
To be �led in person w by mail wiN the County Autliror or Counry Recorder o! the county where the pmpe 's lor�d �
Filirq Dates: 7) Real Property: Musf file during Ne year (or whicA Ne deduction is sought. Counry Auditnr
2) Mo6de /Manulactuied Homes rrot assessed as Real Property Must file dunng the nveNe (72) mo�Jp$, ,���n
before March 37 0/ eacA year the deducfion is sought. IV U V � Counry Recorder
See 2verse side fw additronal instrucfions arrd quali�rafions.
MP�nt(ounerwcontra 6vyer'se� sficJ+el35O^ri"�Se�e) . .s�. ,�.�sc�
1:�1
I( M. Wh3l k5Iti5 ( hPl ¢Y2f2 Sh8f8 Oi V12ClE5i?
If rume m mmd is diife2nt than Nat of aPP�^L md'vzte beb�r.
Name ot mort�zgee or cono-act
Addrea of mortgagee w wntr[
Y�
��.
Name of asvgnee w oNei wmer rn hdder ot mort9age
AdCress of assignee (num0er aM slreeL �y. sbte, and ZIP cotle)
Ooes ePplicant ovm property in eny oNer If yes, what
cwnry m IndFana? I"'1 .,_ _ I"I .._
2� � 20
1 I We certiy urWedthe penal
owner/contracl6uyerofthe
-aoa-noa.co
e6tetlnass unoaid az of Monaaoe / Conr
If owned with someorie other Ihan
btedness unpaiE as of Is Ne appi'xanl ihe sNe
kgal or eQURable owne(.�
� ❑ Yes ❑ No
. iMiote wM whwn
Is Cce property in puestion: MnuaM Assesse0
❑ Rea� amaem ❑ a,�wa�y n�esua _
Df�1YC1' 1�...�W I...�.....
� 3 a4 �
c1,�a �o . .....................
_ � li�s,3�o.�
;ted an pmpeny
Yes ❑ No
20 20
Counry oate (month, daY. �
' I-J3 -o�
h above aM (oregoing infortnatlon is We and cortect afM ihat the applirant is a resident of IrWiana arrci
operty on date applicalion is filed.
Oate (monfh, day, }rea�
II resiEent address W appfmant (num0er entl sLee4 mi; �te, and 21P ootle
�i sz� E o4K sf, P�,��el����- y1b10
Pelson autlq(aed Gy dWy esewced Power of Attorney or by IC 61.1-12-0.7
Pddress of autharaed person (number a� sfree4 �Y. �te, and LP code) .
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