Mortgage_Lewis, �! ' •
e�,"•'�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township
-a._ _� FOR DEDUCTION FROM ASSESSED VALUATION n I
f��'. .i�' State Fortn 43709 (R71 / 8-09) �� I'1 �� �
� ' Prewi6ed by Department of Local Govemment Finance �' V�
INSTRUCTIONS: �
To be filed in person o� by mail.
Filing Dates: 7) Real Property: Must be compleied and dated in fhe calendar year (or which the deduction is sought.
Must be Tled with the CountyAuditor or County Recordei o7 the county where the pioperty rs located
on oi before January 5 of fhe immediately succeeding calendar year.
2J Mobile /Manu/actured Homes nnt assessed as Real Property Must file wifh fhe CountyAuditor of the
county �ihere fhe property is located dunng the hveNe (72J months before March 31 0; each year the
deduction is sought.
See reverse side /oraddifional insfructrons and qual�cations.
Apa��y (ownery lydU buyer - see restncfions on reverse•side)
U(�VI/Y�_ V �f1i�Q L. l_PLJIS
number / legal descnplion
� I - - o- Eo`f . 515- �
MoM1gage / Contracl indebledness unpaid as of Mort
March 1, curtent year date
If rro, xmat is Itis I her ezact share of inie2st?
tl name on recoN is di3erent ihan �hal of applipnt, indicate beb�n^
ot mort9agee or
Oi.t-��WQ,
:s of rtrortgagee
Name of assignee or other ovmer or holtler of mortgage
Address of assiqnee (numberantl street, oty, state. antl ZIP cotle)
owned with
Does applirant own omperty in any other I If yes, whai counry? I What Tadng Dismct7
counry in Intliana?
n Yes vi��.1Jo
Year
V `-� �
��QUptyAudi;or
Illi
73Jnty Recorder
to5t
unpaid as of
�'Yes ❑ No
Ihan spouse, indifate wiN whwr�
Is Ihe property in ques•.ion: Mnualty Pssessed
�Real Property Q MnuallyPSSessed
Mobile Home (IC 6
� . n
Has this tleCUCtion been requestatl on pmperry
fw cUrtent year?
n Yes n No
l"1
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