HomeMy WebLinkAboutMortgage_MillerFarm.i Re.ixd 19a1 FViee Fre SIAO
Prencnbed by tFe S�am Hoeed o(Tex Commissionen
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CERTIFICATE OF MORTG�E OR CONTRACT INDEBTEDNESS
TO BE LED IN PF.RSON OR BY MAIL IN DUPLIC TE EACH YEAR BY THE OWNER WITH THE COUNTY AUDITOR
� pN R'HICH THE PROPERTY IS LOCA/ D) BE'I'wEEN MARCH 1 AND MAY lq INCLUSIVE
(6-1.1-12-1 THROU(�iH 6-1.1-12-8)
� .'^QUALIFICATIONS ON BACK••• ' 1'^
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STATE OF INDIANA
COUNTY, ss:
I, (We) w��..v+ . � �
IFULL RAME1
certify that I, (We) was/weze legal resident(s) of the State of Indiana and owner(s) of real property an Mazch 1, 19 � and that this
statement is made Cor the purpose of obtaining a deducfion from that real pro�cated in Taxing�District (City, Town, Township)
�.[�.iC.U�.I-6ti'-� �"u � Described to wit
Legal Description/or Key Number \' �-, V W I/� �O •�" � I�•� u ii�
Name on property tax records if different Crom above? OfV '�� �Q'��� �6�•`� 3 b�Q��
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A
z Are you the sole legal or equitable owner of the real estate? Yes � No
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� If no, what is your.exact share of interest in it?
� Assessed value of real estate as of March 1, current year
W. Amount of Mortgage or Contract Indeb[edness unpaid as of March 1, cunent yeaz S
� .
MoRgage or Contract recorded County Recorder's Office,
"' Name and address of mortgagee or contract seller ��� v`�""
W
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No. � Page
W Do you know if there is any assignee or bona fide owner or holder of the mortgage or rnntract? Yes
� Q what is the name and residence?
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� z Does the owner of the above described real property own real property in any other Co t;
F-I
� Pes No �. If yes, what County and Taxing District?
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Qi Has this deduction been requested on that property for the current year? Yes No
�
f/1 Amount Allowed "
x � Db��e��
F
z COUNTY BOARD OF REVIEW
,.,, � � ��„ � � ACTION
[.Wy APPROVED IN AMOUNT OF $
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3 REMARKS
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A SECRETARY OF BOARD
- 6611
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_., No�/ If yes,
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in the State of Indiana?
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—13�b~ `S�e False Statement Penalty BeIbW'�""�� ��u�s
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�(`/ AUDITOR
i���i���W\ER•5 FUIL 1Ao E� �
�PER50\ AUTHORIZF.II BY DULY EXECUTF.D POWER OF ATNRIEY)
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��FULL RESID .'CE ADDRFSS OF OW\ER — JNST BE GIVEYI
/ICl/%LG�Q.ct� �..�/ y �7 /o V 9
IA�DRFSS OF AUTHORIZED PERS \1
�ATE � �� a3� fy n� n a ooY ��
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