HomeMy WebLinkAboutMortgage_Hirsch ..., . STATEMENT OF MORTGAGE OR CONTRACT I N 1 ounry Township Year
eiS f,- FOR DEDUCTION FROM ASSESSED VALUATI N
State Pore 43709(R11/5-09)
Prescribed by Department of local Government Finance
MAR 21 2014 File Mark
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor or Court Recorder of the county ` 4 1 Form Ned with:
Filing Dates: 1) Real Property Must file during the b b; •-$ the. 17,11 . -tea.
mg r1g year for which the deduction is so .,t ��lrttl j1 i ❑ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property MV t��77gg +•r'. Ub protils
before March 31 of each year the deduction is sought. GIBS U ❑ County Recorder
See reverse side for additional instructions and qualificatio . -
gpplrant(owner.. .. ..�� - , . . :.� .:�
TatDistrict - b�_t�1 esm7p(ym.J iir fir)
iV IVL.I ilk . �7��`✓ l 5-4 0 —cc°.w3—0 Reaxd Page�eun g
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is t e applicant the sole
March 1,asrerrt year March 1,cement T date of application legal or equitable ownert
I CO COD ❑ Yes ❑ No
If o a share,what his t her enact sha of interest? l 1 if owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
ff ❑Real Property ❑Annually Assessed
C l y 'IJ ^ Mobile Home(IC 6-1.1-7)
Name of nongagee or contract seller 1.�i-e---
Address of mortgagee or contract seller(number and street,city,staff,and ZIP code)
Name of assignee or other owner or holden O l q.......
Address of assignee(number Street cn vl:l\`�el ��/^�1(' r ----
Does applicant own property in any other O• ,...•••.. .•••• .. . Has this deduction been requested on property
aunty in Indiana? ❑ Yes E C`l 1 (] N far current year? ❑ Yes No
....uNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20_ 20 20
Sign ...f ty _itor County Date(month,day,year)
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/..ntract buyer of the mentioned perry on date application is filed.
fhAro ) Date(month,day,year)
3
nt 6 g3ap (number S/� 6 ft— ry,%r ZlPcode.11/G/1 l� It 76 y �Zi LD13 .and
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date Date(mon h,day,year)
Address of authorized person (number and steel city,state.and ZIP code) •