HomeMy WebLinkAboutMortgage_LewispSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09)
S aresaihea M��� �� Caremme�rc Fu�arice
� F' rk
INSTRUCTIONS: F� � �:
To be fded in person or by mail with the CounryAUditor or Counry Recorder o/ fhe counry where the properry is located- q q /'I �
Fitirg Da[es: 7) Real Property: Must file during the year for which Ne deduction is soughG � P C.61u�f¢ /i�tf�
2) Mo6Be / ManufaGured Homes rat assessed as Real Proper(y Must file dunng the nveHe (12) mrnths
6efora March 37 of each year Ne deducdon is sought �0 �^�' R�O�w
i
See reverse side 7or adtlitional insUUCtbns end quelifications. l' "� '
nPpf�pm(y�.r�rcrco„rraqp,ryer-see mre.e ') , SON COUNTY AUDiTOF
� raLe af rr�l popeny es a
alrerrt year
/ het e�otl share a1 interest?
tt �ame m remd "s Qitferen[ Can tlul of
Nartre of mort9a9� a �ntraf2
.a�v-a�.�i-
Abrtpage I Contract'ude6tednma unpaid as U Mongage /
Ma� 7, wrterrt year date of eppl
someorie
Address d rtnrigagee or mntract se0er (nwemg and sfrceL �'. sbm. arW LP mdej
Name N asignee a aher wmer ar holder d morigage -� \ O � .
Dra�ver 1 "�b��.....
AdEress M assgnee (numDer and stree4 �: s+ete, anE 2 � 1 ^'^
���,,,����,YO�g ��: c�t�a �o. ..3
iYW�.........
�^�'���' r-i .,__ n .�_
Pi�]
Sy�tl�re
or.
p— � p— � 20— � p—
bteCness �mGaid as d Is Ne ePP���
�_^ — legal O rtahl
.f N .t�\
«-�_J Yes
sppae. ud'nate with vAwm
Real P(OPertY ❑
as Mis dedumon Emn reGUestetl on P�P�Y
r artmt Y�n ❑ Ye5 ❑
�
Date (rnoivn.
20
No
1 I We cerUfy u�er Ne penalry of perjury that the above and foregoing infomiation is We and cortec[ arW ihat the applinnt is a residant of IMiana aM
owner! contracl buyer of ihe aforementioned property on date application is filed.
SiBnaWre (owrie !u9 na ) Date (rmvh. daY. N��
--,� � -�_�,.% c.i � _ .
r1/v � 60G
�n a�u�«a�a er a�er exearea a�
ldOress af auCrarsed 7cson
� ��, �
stete. and LP mde)
��
� � ��. �y.,�, _