HomeMy WebLinkAboutMortgage_Hirsch (9)Nn STATEMENT OF MORTGAGE OR
_ _ ; FOR DEDUCTION FROM ASSES:
� c Sfate Fam 43709 (R17 / 6-09)
,' ,w � Presrnbetl M DepartmeM of Local Govemrtrent Flrianc.
wsrRUCnoNS: DEC `L 8? 1 i?
To be fiied in person w 6y maii with the CountyAuditw or Counry Recorder of ttLe u� the property is lorated.
Fiiirg Dates: 1) Real Pmperty: Must 61e dufig the year (or which the deducUon is sough
2) Mo6ile / Manufactured Homes rrot assessed as Real Pmperty Must file du " t Ive (12J months
6ePore March 31 of each year the deduction is xwghG G I B SON COU NTY A U D ITO R
See reverse side (or edditional instrucfions arM qual�cations.
Appfiwnt(rnmeror�ttratAbuye�-seeresLirb'OU�smmve�ms/e . .
%� P�D�Y �
�
ro.
It �rtie m remd'a ddfuent than Ihai oi app&an1, uWirate bebvl
Name oi mort9agee ar mntraU se9er
ACdress of mwtgagce w contract
ommer
strBe4
of assgnee (numEer aM sLeet, ary, state, and LP ootla)
Dces applitanl own prapeny in any oNer I If yes, whal munty7
oourLLy in Ind'au? ❑ Y25
❑ No
zo � zo � 20
I/ We certify under the penalry of j�rjury that the
owner I contrad buyer ot ihe aforemenboned pm�
s��m� �/ �it/�'� S C.�
cn�ay
d az of Mwigage I Contraa
date af appGption
J
Wtut Taring OStrictT o
spouse,
File Mark
Farm Nad with:
unry Auditnr
❑ County Recorder
Inumber Pagen /
1 �� y
as of Is the aPP��t tlx sde
1e9a1 w equitade owner
n Yes ❑ No
IS CIC ProP�rtY 111 Q�ICSLCII: Mf1113OY ASSCSSG�
❑ Real Property ❑ Mnualiy A�ses.sed
Mod'le Home (IC 61.
Uiis detluCirn Eeen reGUested m P�De+�Y
unentyeaY? I-1 .,__ I-1
�s��' � S � �a-� �v
����.�„�S�.C,E, �`�zp
1
� � 5v oo" `'' ` �
date a � A fio.! w��`
�
�a-ao— io
3 resident ot Indiana aM
�r, rge
�'2��iz
ss at a t�numoer arq snee4 aN. �re, entl zra oo0e)
y arvi ��✓ �/-f� �...h rf� cft rn/ S'-7 �� 9
oy awr ���a a�� wnnd„�y � oy ic ��.�-i z-0.� oare �R,ann, aar. r�
AOCmss of autho�'¢Ed person (num6er arM sbee; city, state, antl LP ootle)
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