HomeMy WebLinkAboutMortgage_Kirsch _.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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% State Form 43709(R14 I 1-20) 1 L
Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: To be filed in person or by mail. F rm f d with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
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Appliyazaj or�ntr uy e restricbons on r verse side)
L\1 VS Record number f Page numb
Taxing tact ber legal description �/-f R. I �` J•
2 i\—\ 2— c��-( 81 \ �J L /yam_>L l 1 C$
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgag /Contract indebtedness unpaid as of Is legalthe or li t the sole
able owner?
assessment date,current year assessment date,current year date of plica ion �^ V
1\�/ 1 J\ Yes El No
If no,what is his/her exact share of interest? If owned with so one other than Espouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessedeal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller( er and stye y,skate,and ZIP code) T
Name of assignee or other owner or holder of mortgage IL L,J -�
Address of assignee(number and street.city,state,and ZIP code) FL
Does applicant own property in any If
this deduction en requested I If y Btelartut.VPteduction
,roperty for
i E` 1,V
other nIndiana?county ❑ El No
•�❑Yes No ent year? Yes
A person is not entitled to this deduc 9 Drt9 a e or c ntr ct indeb a ess that is re orde in a county
recorder's office(including any home /� der's office that the bat hi1113�a*d t-pLrW)
4
Drawer INTO 026••�•1...... GIBSON COON I r AUUI I LW(
Deduction approved in the amount of: j
Card NO.20 20 20 I 20 20
Date(tt ay,y :._)._._wz Signature of Cou Audito 6� Jor Z
I/We certify under the penalty of perjury that the above and foregoing information is true correct and that the applicant is a reside of Indiana and
owner •ontract buyer of the aforementioned property on date application is filed. I Date(mo h.�ad,tg-t,$)Z .
Signatur- ner's full;me) ////////// b
Full resid-ai ad_ of ap li trb\er d Eger,city �nd ZIP�e)
ers`n a L \1111 ip /V� Date(month,day,year)
Person authorized by duly executed Power/ Attorr�;y or by IC 6-1.1-12-0.7
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$10,000.
RECEIPT F
R
FILING STATEMENT OF MORTGAGE OR CONTRACT IN =
Na plicant 1 , I( \ 'S6"^I I Name��lort9agee c nt ct II r r ,
�d th l Yk51/4'‘.1\ I/\� v�(/ mil\
Amount of in ebte ss ` Taxin District ^ "1
Date filed h�ar,year \1 'L/�"rl
O C� 2 f' 1 6 2022
Key number ega=disc,spfio� ��--,^� t,
\ (/// _1 I County \ ' �f !� y •r f'h 1a year- ) 2_
Sign ure of unty Au r/Cou i Recorder County
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