HomeMy WebLinkAboutMortgage_Hirsch (5) r—
! •n:n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
iz.0 .� �a Coun Townshis Year
1.,. 4� A FOR DEDUCTION FROM ASSESSED VALUATION
j r S" it State Form 43709(R11 /&14) 2015
Li L °S� �e Prescribed by Department of Local Government Finance If�Ma
.I su �H I
.INSTRUCTIONS:
To be filled in person or by mail. Form f led with
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 1' 1
Must be filed or postmarked with the County Auditor or County Recorder of the county where the ''u� 1 cry Auditor
I i property is located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
y;_ 2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
i deduction is sought. GIBSp
See reverse side for additional instructions and qualifications. N COUNTY A11nIT
, Applicant(owner or contract buyer-see restrictions on reverse side) O1r
e Alexander J. Hirsch
I- Taxing District Key number/legal description 26-18-13-402-000/77-026/504 North Main Record number Page number
1 Street, Fort Branch, Indiana 47648
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/ ' i 15 421450
26-18-13-402-000.777-026
( Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
€- March 1,current year March 1,current year date of application legal or equitable owner?
r- $85,399.00 '151-Yes ❑ No
1 If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
r
I, :
i If name on record is different than that of applicant,indicate below: I Is the property in question: Annually Assessed
I.4 ; -- - I3Real Property ❑Annually Assessed
} Name of mortgagee or contract seller -y� Mobile Home(IC 6-1.1-7)
Drawer iVO.°C`r! 5
f' Hometown Lenders LLC
ik Address of mortgagee or contract seller(number and si '1 'P 0
310 The Bridge Street,4TH Floor Suite A, Hut Card NO.
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Name of assignee or other owner or holder of mortgage cubw..4na9 t Cl• t4
rAddress of assignee(number and street,city,state,and ZIP code) O'
i •
IDoes applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of
r other county on property for deduction
'- in Indiana? ❑ Yes Q.-No current year? ❑ Yes ❑ No
TIA
.. :,/ COUNTY AUDITOR
1 Deduction approved in the amount of:
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It
1 ' 20 20 20 20 20 20 20
I i
1 Signature of County Auditor County Date(month,day,year)
4i
I ; I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
1 : owner/contract buyer of the aforementioned property on date application is filed.
natur,,e,(ow er's full name) Date(month,day.year)
Full resident address of applicant(number and street,city,state, and ZIP code)
It 504 North Main Street, Fort Branch, IN 47648
Person authorized by duty executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
1 -
Address of authorized person(number and street,city,state,and ZIP code) ■
to
s-
r IThe penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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