HomeMy WebLinkAboutMortgage_Hirsch (8) <4;7 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1/ �►,;.� County Township Year-�i= FOR DEDUCTION FROM ASSESSED VALUATION
°'- ',`, a1= (R14 ) G'son 026 2020
'.�t -;}", State Form 43709 /1-20
`4--i. Prescribed by Department of Local Government Finance
%ems
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. IZI County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are
Applicant(owner or contract buyer-see restrictions on reverse side)
Hirsch, Timothy E
Taxing District Key number/legal description Record number Page number
026 26-19-19-204-001.340-026 2020 5186
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$ 183,000 ElYes ❑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
IZI Real Property ['Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
' Haub Stte Bank F'LLD
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
NOV 17 2020
Name of assignee or other owner or holder of mortgage
Address ,:ci,fnemcca---------
of assignee(number and street,city,state,and ZIP code)
CIcsoN ( OUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has is deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? III Yes ❑No current year? ®Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20
Signature of County Au 'o County Date(month,day,year)
11/17/2020
I/We certi under penalty of pe ry tha he a ov an oregoing 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.
Signature{owner's full name) �;� Date(month,day,year)
1 i'� ca� 4b 11/17/2020,year)
Full real en addre of applicant(numb r and street,city,state,and ZIP code)
252 E 800 S, Ft Branch, IN 47648
Person authorized by duly 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)