HomeMy WebLinkAboutMortgage_Hirsch (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.�}� FOR DEDUCTION FROM ASSESSED VALUATION
•'6t'.-}-'' State Fonn 43709(R73/10.15) g
--' Prescribed by Department of Local Government Finance J File Mark
INSTRUCTIONS:
To be Ned in person or by mail. Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for ntAMifs dettuction islsought ,�,/'
Must be filed or postmarked with the County Auditor or County Recorder of &CI r where rthe properly is 1r County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the CountyA ttoref-the county County Recorder
where the properly is located during the lwehe(12)months before March 3t$eua p�uGion is sought
See reverse side nor itional instructions and qualifications. N�'
4�p�p�\ ��y/�• CIQrn•r r`ni urrV fir Inn-roe
Appfrant(owner or ` 'i/seeressbr�arx n reverse
�"siside) _
T nu /legal description �1 r Record null r e ben
G-II)-cif-aoo -oo 1 - 1 Fe-oc7.� 17 1 3d
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,clurertt year assessmen -.fa, sn r date of application legal or equitable owner?
1O ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract saner /�
1IYPcode) corn a txt t‘71" ---'
Address of mortgagee or contract seller(number and city,state,and 2fP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,state,and
RobYv. k. w\ rs
Does applicant own property in any If yes,what count 1 n toasted If yes,state amount of deduction
finnddianna?y ❑Yes ❑No CU b�QQ"
❑No
A person is not entitled to this deduction unless th 11-6 - n hdebtedness That is recorded in the county
recorder's office(including any home equity line o �o O \�—��3 e basis for the deduction.
I 4 \--.. tboo . oo
Deduction approved in the amount of.
20 20 '��20///'' 20 20 20 20
Signatu my Auditor
/ County • Date(month,day,year)
I/We certify under the
II of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
/��(Sii�gnature(• = 7 H%nor/m/p��' / Date(month,day,year)
IF - •_, d$p gr)( umber an state.and ZIP code) P ��/�r�
Persicn authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.