HomeMy WebLinkAboutMortgage_Hirsch (5) f ate. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,, ,*;:, FOR DEDUCTION FROM ASSESSED VALUATION
.:-1':. -1 State Form 43709(R11/6-09)
w- P ibdby Depamnent ofl�l Government Finance F IL
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is locatl Form filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. J U L 3 ��3County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought. - ���Recorder
See reverse side for additional instructions and qualifications.
Apps orCenbaCf buyer-SOO rel GIBSON COUNTY AUDITOR
T r0" Key number/legal description Record number Page number
r/e. L ; di, - 19-19 - , 0E/-pot 33 9-0-lip X0 / 3 3.539
Assessed value of real pmpar y as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Marts 1,cunt year Marti ,aurent `? date of application legal or equitable owner?
/ J) ro0 0 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,Indicate below:
Is the property in question:ArvwaDy Assessed
❑Real Property ❑Annually Assessed
Mobde Home QC 6-1.1-7)
Name of mortgagee or contract seller pppppp
Address of mortgagee or contract seller(number and I.city:state,ant ZIP
-
Name of assignee or other owner or holder of mortgage --— _
Address of "gnee(number and street e,and ZIP code) L
rI7 (0 3 Drawer- �O
Does in India own property in any other If yes,what county? what Taxing D"saic CI- i 1 O•-...,, I
county in Indiana? •• ........
❑ Yes ❑ No f
CaI-fJ )NO. 353gr
COUNTY AUDITOR ••
Deduction approved in the amount at X3,9']% 8.6•.•.
20 20 20 20 20 20 20
Signs of County Auditor County Date(month,day,year)
V
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract • -r of the aforementioned property on date application is filed.
xSig -,.. -(o- .n • -me) Date(month,day,year)
Ful ent.•.• •/of applicant(number and street city, and ZIP code)
/y\ 7,�7 C �� �- ,7: /3r tip/ S,J
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0-7 Date(month,day,year)
Address of authonzed person (number and street dy stare,and ZIP code) _