HomeMy WebLinkAboutMortgage_Lewis (12)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
�. FOR DEDUCTION FROM ASSESSED VALUATION �
s�a F� aa�oe (Rio inos) �
` � Presai6ed bY �rtmant d Loml GovemmeM Finan�
INSTRUCTIONS: File Merk
waan,ad;��,:«,aay,�a�;a,urec«l.�awaadma�.�ryWna,�waa�vartr���rae. JUN 2 9 2009
tiling Dates: iJ Real Property: Must fde dlving the year )or which the tledudion is sought.
2) Mobde/Manulactured Homes rrot assessed as Real Property: Must file dunrg tlre tweNe (12) monUu be(ara,AlgrGt 31 of each yea�
the deduction is sought. � U� �
See ieverse side far edddiona! ir�,sWCfions and 4ualifications
Appliram (o�i u wnfra�i Mryw - see,rmjn'qims m r90Yise side) . � rf
�t�� � (O — - U .7 -
wcrossee vawe a�l Oroperry as a Mortaaaa � cantracf udewedire:
A4rt�l� 1. amain year t.lamh 1, aara�rt year
I
U ro. what q hb / her exad shara N irMeresl7
Y name on �emd is Cdferam Uan Ihal ot apG��l iMi-afe beb.r.
Narna of matgagee or mN'aCI 5e0er ��
Addrass d rtnn8agae u coniratl se0er antl a�oet �Y• sfafe, and ZIP coo
Name d suigrrea or olher ovmer a hdder d �mtgape
ooas appGram a.m popeny in arry w�ar
camty in ItMiarel (
❑ Yes
Deduction a70roveC in ihe amour� d:
20 20
Recor�numDer number
o�o0 9 � o �
�e / Contrad indebtednass un�aid a5 d Is Ihe appGraM tlfe wle
�°tion lagal w equ3ada own¢R
(p ❑ Yes ❑ No
�eo�re har n spouse, indicale with wlm�
�s me a�M � a��: am�q az�uee
❑ Rea1 PmpeAy ❑ AnnuauyAssessed
Mohik Fbme QC 61.1-i
._'— �I'1\\'CC ��...9�04[.L. .. ..
C:1C(1 \�. ...J.I�`f..........
No � �
COUNTY AUDITOR
20 20 20
�h
,� g�,3�B.�
20
20
[.l
1/ We certify unCer the penaity af perjury p�at the above aM faegdng rt�fartnatim is We and corred and Ihat the appliwnt is a resident of Inda� aM
owner / contrad huyer of �he aforementioned poperry on tlate aPDlication is filed.
�/' , ���� � /l � � . �. . Oata (rtronfh. daY. YPar)
Oate
Address d autMrized 7arson (number