HomeMy WebLinkAboutMortgage_Dewig (6)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township '
FOR DEDUCTION FROM ASSESSED VALUATION
swa Fo�r� aa�os �rtio n ioa�
` � Prasaibed bY �mnant of Lor� Govemmerd F'vurce
Filirg Dat sO i) Real Property: Must fJe dunng the yeer for which fhe dedudion is sought. �� Fle ��
To be fded in person or 6y mad witli fhe CountyAuditor d ffie wunty wirere the poperty is located.
2) MobDe / Manufectured Homes not assessed es Real Pmperty: Musf fde dunm� tlie hveNe (12) mmNU belore Malch 31 0l each yeer
�e'�`�°°'S�'` JUN 0 9 2009
s� r��� gda ror ead�o� ��we�o� end a�er�eo��
na�rran (o ooM,an a,m- ���/iqim m �o�Q si�ea . //�/
�O AM � 7111/IDM L V1J �►l A� �a<n N/Ja"�
- �W_�►,_�n—
assessea vau» araa� a�ny a, d
A1�cn t a�am year
N no. whal p ho / her e�ad share d imetesll
on
v
a mniraa
ot aoc�. inOirare batrr.
�:
.�K a �oq �� so� °
riedresv unpai0 es M Morlgaga I Conlratl mEebtedness w{eid as d
� dateo(applimtion
I( onned wich someorre altrer �han spouse, indicale wiih w
Name d assipnee of ofha oxner a holder of mMpape
Addrass d assipnea (rwmba aM sbe.wL �Y• �ti �(��� �C.z�: • F • • • • • • • • •
j)C.l\\'C1" l �..; ...
Does aPpliwnt am poperty in arry dhar . ,
tauMy in Indana7 � Yes ❑ No � � � . • • • • • • . • • •
C:il'CI �0' j9��U�. :�
Deducfion apprwed'm Iha artpuM d:
20 �_
�
Sipnalura d CouMy <
I / We certify u
owner / mn
iignature (
�Q•
Person auNaaetl by
20 _ � 20 _ � 20 � 20
Yes ❑ No
Is tl�e G��nY in Guestim: MmiaOy 0.ssessed
�Real Proparty Q Mnualryl�ssessed
tlas ws deduaion eaan rea�as+ad «i v�waM
lor airtam yeaR
❑ Yes ❑ No
20 � 20
penalty of peryry�nat the above and faegdng'v�fortnation is true aM correct and [hal lhe a�rant is a resAent of India� aM
of ihe afa�ient� ned property on date applintbn is filed.
ed
�/I � Data (rtrorRh. daY•Y��
tl appGCantTnienAer md sboet ciy, s6tr�. and LP oodo)
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i�,y a�me ro«er a nnomay «ai �c s-�. �-�20.�
panm (nivnDOr and sLVOI, rity, sbte. antl LP mtlo)
os r�' � i� s.v �/`%6 3
Oate (imth, day, �mar)