HomeMy WebLinkAboutMortgage_Lewis (4)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
� ; FOR DEDUCTION FROM ASSESSED VALUATION
Siate Fam 03709 (R71 / 6-09)
� ` PresmbeO M OeP��n� of LoW Govemment Friance
�«.
INSTRUCTIONS: .
b 6e filed in person or by mail wifh the CountyAUditw w Counry Recorder o( the oo�nry where the pioperry is located.
FIMg Dafes: 7) Real Property: Must file dunrg the year for which the deduction is sought.
2) Mo6i7e / Manu/actured Homes irot assessed as Real Property: Musf file dunrg the hvelve (12) months
before Ma/ch 37 o(each yearthe deduclion rs sought.
See reversa side for addilional inshuctlons and qualifications.
Appfaanil ort9rivaCbuy�r-see mla�erseside)
_ _.
A� �� LUIu
ry Auditor
❑ Counry Record�
r,�gSON
f�y �w / legal desaiGUan Q c7. �(O d� — � o� RemN numher Paee number
a�"��3-i�- �-� a��o i3��
as ot Mortgage/ Contract indehtedness unpaid az W Mortgage I Contrxt "uWebteCrress unpaid as d Is Ne app&znt fhe sde
Metch 1, arreM Y� date of eP le9al n M���de wme/?
��d (p 9 ❑ Yes ❑ No
tt ro, what Is his I her ezaG share of inteRSt? If owned wkh someme dhar Man spouse, fndxata wiM wMm
tt name m iemN "s Ettterent t�an Ihat ol aOP�M ��� ce�' Is the proputy in Ouestion: MnuaOy AssesuE
� Real PropertY ❑ �Y �
Name o( rt�qtgagee m m�bact uYer
Addtxa o1 imtaaaeE or mntrad Se�U
Name of assi�ee w atha owner or holder of mortgage
naaress or assgnee Inumoer arn anee4 m3: ��.
Does e�itlnl am O�GenY in 2nY oNa
munry m Ind'ana? ❑ Yes
❑ No
Deductian appnveE In tlx amounl oF:
20 _ 20 _
Signanne of CounN Autlitor
I I W ce{�fy under Ney e,nally eryury tl
own I tlontract buy f of the m
Sig eW eYSfiNn
{
' entadErnssdaoof t(rwmDefeMSbe
�_
the and fc
rty on date
, Spte. 3M ZIP i
COUNTYAUDROR
o_
�raiv��-i�,p ���0 _
��-Card i\'p. /,3(0� • .
r'�� ��� '• ,
�G9. °_.� .
20 _ 20 20 20 _
Caunry Date (month, daY. S��
ig infwmation is true and cortect a`M Uat Ne applirant is a resident o( I(Wiana arM
�tion is filed. �
Data (monM. deY. Y��
vl � /[i f�/\ �-- i „'�( i -�/i - /
authp�d Gdy ezecuted Pov.er o(Attomey or Cy IC 61.7-12-0.� �� (�N. �Y. Y��
i of e�Matred Ce� (numbera�W sbeeL dN• sta�e, eM LP aoda) .