HomeMy WebLinkAboutMortgage_ModafariForm i fle.ised 14i1 � .
Prescnbed bY �e Sta� Baerd of Tax Com.aissianers .
CERTIFICATE OF MORTGAGE OR C�
TO BE FILED IN PERSON OR BY MAIL IN DUPLICAT . Y
ph R'HICH THE PROPERTS IS LOCATED) 7'R
��(61.1424 THR GH
� "'QUALIFICATIO 'S ON
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STATE OF INDIANA
Filing Px S1A0
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TRACTINDEBTEDNESS
4R Y THE OWNER RITH THE COUNTY AUDITOR
MAR H 1 AND MAY 10, INCLUSIVE
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COUNTY, ss.
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IFUIL . ME) .
certify that I, (1 e) w•as/were legal resident(s) of the State of Indiana and owner(s) of real property on Mazch 1, 19 and that this
statement is made for the purpose of obtaining a deduction from that rea] property located in �Taxing District (City, Town, Township)
�
Legal Description/or Key Number _
Name on property ts�c records if differen[ from above?
Are you the sole legal or equitable owner o( the real estate? Yes
It no, what is your exact shaze of interest in it?
Assessed value of real estate as of March 1, current year
o-a-q ,g3o
No
Described to wit:
�9 — 3�-4�'7
Amount of 1H'�—g?t��{�efgJe or acFl��ndebtedness unpaid as of n7arch 1, current year 3 -�'��v
1NortRa�e orGdntenc ��[-reco�� County- Recorder's Office, Record Yo. � Page ..L�
Name and addr��s iOF�nOrtgage0lor contract seller
Do you kn f i��a�y�,ySS�j or bona fide owner or holder of the mortgage or contract? Yes
V
AU�I?OF; �
what is the name an residence? .,r�'
No If yes,
Does the owner of the above described real property own real property in any other County in the State of Indiana?
Yes No _
Has [his deduction
Amount Allowed _
_ If yes, what County and Taxing Distric[?
i
requested on that property for the cuaent year? Yes No S��( �
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�OARD OF
ACTION
APPROVED IN AMOUNT OF S
A � � SECRETARI' OF BO.�RD
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'See False Statement Penalty Below -� 9��� /C-
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1 K'p"E 'n FU NAMEI
IPF.R506 AU7}IOftIZED BY WLy E%ECITI'ED POWER OF ATIOR.\EY)
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�fFULL RFSIOENCE ADORFSS OF ON'\ER — AIUST BE CIVEN�
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