HomeMy WebLinkAboutMortgage_Lewis (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ � FOR DEDUCTION FROM ASSESSED VALUATION
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INSTRUCTIONS:
To be filed in person or by mail wiN the CountyAUditor or Counry RecoNer o( the county where the propeRy is located J t: i �� �/�� IU
Fil'mg Dates: i) Real Property: Must fi!e dunng fhe year for which (he deduction is sought �j' rrCOUnty Audiwr
2) Mobde /Manu/auured Hanes not assessed as Real Praperty: Must file dunng the fwelve (12) monfhs 1�/
before Malch 37 oleach yearNe deduction is mught. . LCJ �^b R��
,/y/ � _
See re�se side for addtional inshucLOns end qualifiwfions. � v�' `� �' �
Ap :t(o wcpntr�tb r- ee �� , revarsesjfa) � � o � GIRSON COUNTY AUDI70R
/ III
n�sea value a real properry as
MarU 1, a+ren� year
tt no, what Is his / her eraa share
If rwne m remN is QittereN Nan Ihal af aPP���. hldirate bebw:
oonvart seAer
mor[ga9ee ar wntratl
ovmef or MIGer M rtqrtgage
Ada�es5 of astigtle8 (maMrJ erld bfreet �sl: 578te. and LPCotle)
A..C�I,I.�-- � � LR-lL�..� sunt�/1
Qm-i� � b?�.�o =
If owneC with somewie
What Ta�drg District?
az
legal a eQUitade wme(+
❑ Yes ❑ No
wtrom
Is the properry in Ouestion: MnuaOy Assessetl
❑ Real Roperty ❑ ArmuallyAssessed
Has ihis deductim Eeen re9ueste0 m P�Y
Por artent year? � �,� � No
c�0/U - ��3�
. 2� 20 2(1 20
wre iror Counh Date (rz�dWi. daY. Y��) C
� O �
I/ We certi(y nder the alry of perjury that the arM foregoing infortnalion is We and cortec[ and Nat Ne apP��mnt is a resident of IrWiana arW
owner I contraa buyer of e afaementioned p on date application is filed.
3_� (omie/s Np �mme) �. ^ Date (rt�W. daY. Y�
'-_'T'i.�.l
Date (monM, d2Y.
Adtlr� af aWmr�d person (numberand snee; dry, sfale, antl ZIP oode)
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