HomeMy WebLinkAboutMortgage_Lewis�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r' F FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�. / State FOrtn 43709 (RS / 4-03)
� �A.
PresaiOeC by Departmant of Laal Govemment Finance
MAY 9 2005
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county whe�e the property is located.
Filing Dates: 1 J Real Property: During the 72 months before May 77 0/ the yea� the deduction is to b� �v�
2) Mobile Homes assessed under IC 6-1.7-7: Befween January 15 and March 2 GIBS(�N a�� �(1'f4F�o be effective.
See reverse side !or additional instructions and qualifications.
Applic�nt lowne� or�ontract buy� see resf�cti�s on reverse side) �
number / legal description
G � � -��? L,-
�d numb� y _ � g, a �
number .
Assessed value of real property as of Morigage / Contract indebtedness unpaid as of Is the appiicant the ole legal or equitable
March t, current year March 1, current year owner? es ❑ No
�3900
Ii 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 applicani, indicate below: Is the property in question:
mortgagee or contrect seller r/
'J 3
Address of mortgagee or contraci seller (number and st2et, city, state. ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and stieet, city, sfate, ZIP code)
Property ❑ Mobile Home (IC 61.1-
Drawer NO.C.I..� .. � �a�
Does applicant own property in any other If yes, what county? � Card NO . .....................
county in Indiana?
,� l , � � ,,,� �' COUNTY AUDITOR
Deduction approved in the amount of:
20Q�_ 20
�
Signature
l�
� r.
� �
I U
Couniy Auditor
20
20
Date
20
quested on
] Yes 0 No
' We certify under the penaity of perjury that lhe above and foregoing information is we and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
authorized person