HomeMy WebLinkAboutMortgage_Lewis (8)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
r_ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fam 43709 (R71 / 6-09)
�' � Presaibed by DepartmeM of Loml Govemment Flranca
�NSTRUCT70NS: o��d
To be filed in person or by maif witA the Couny Auditor or Counry Recorder of fhe counry whem the property is located. F fl � I�� 2 Q ��
Fi7irg Dafes: 1 J Real PropeRy: Must fife durirg tha year for which 7he deducfion is soughL "�� County Auditor
2� Mobde / Manufactured Homes rat assessed as Real Property Must fiie dunng fhe hveNe (72J months
6efore March 31 0! each year fhe deduction is swght. �� �'�� er
�
See reverse side for addifional instmcfions and qual�cations.
AppGCar�t l�wner� contraU buye^see restn'rlons m reverse side) e � „. __
A�srssed vahre d real proputy as of
Ma�tll 1. pprent yP3f
If rw, what's ha ! her euG sl�are o( interest?
— , ' 1 .. �
Mortqage / Contraa inEebtedness
March 1, a�rtent yPar
If nama on recwd is Nt(er�[ Nan Ihat of appGCant. "uWicate 6ebw.
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contraG sWer (number and sveeS �y. sbte. arN ZIP code)
Name of assignee w other owner or holder of mwtgage
MCress of assgnee (number aM svee4 �y. slate, antl Z/P cotle)
Ooes applifanl ovm property in any oNer If yes, what
munry in Ind'ana? � . _ }—n .
az
' T�� . Record numbu Page numba
V I lD
ConVaa inCebtetlness unpaid as d Is �he aPW�t Me sole
itation legal w equitade oxne/?
�Yes ❑ No
if awned v.ith soniewie aher Nan spouse. IMicate wifh wtnm
NRat Tanrg
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�L'�l�IS� '�'�V� M
c� y�� r✓'
d
� I"�'1 -
.w �na a�ucfin eeen rea��ed «� v�cem
x current yeaR
❑ Ye5 �
COUNTYAUDROR `
Deducaon app�wed in the amount of:
20 20 _ 20 20 20 _ 20 _ ZO
Signature U CountY Auehor Counry Date (rtmth. daY. Y�a�
I/ We certify under Ne penalry of perjury Ihat Ihe above and (oregoing infortnaUon is We and mrtect arW Nat ihe appliran[ is a resident of IMiana aM
owner I mnVact buyer o( It�e aforemerrtioned property on da[e applicalion is filetl.
Signature ovmerY (ull rame) Date (nonfh. daY. Y'�ah
_�\
Ful retiCem aCdr�s t(number and sheet a1y, s+are. ntl LP ootle)
� y�
�san autlraaed Dy duy execu�etl Power o( Avomey a by IC 6t.1-t2-0.7 Date (month, day, yaa�
,a�
Address o� aufhor'ved person (num6er aM stree4 �: s/afe, antl ZIP code)