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rERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
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TO BF. '±....: �!N PERSON OR $Y MAIL IN DUPLICATE EACH YEAR BY TNE OWNER WITH TNE COUNTY AUDITOR
�-iN WHICH THE PROPERTY IS LOCATED) BETWEEN MARCH 1 AND MAY 10, INCLUSR'E
(6-1.1-12-1 THROUGH 61.1-12-8) { ��
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�'••QUALIFICATIONS ON BACK•'• lys'^./�
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STATE OF INDIANA
Jay RiEfert
Gibson
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COUNTY, ss: ���
certify that I, (We) was/were legal resident(s) of the State of Indiana and owneds) of real property on March 1, 19 —� "and that this
statement is made for the purpose of obtaining a deduction from that real property located in Taxing District (City, Town, Township)
�� '�Q� ,��J'� Described to wit:
Legal Description/or Key Number lot No. 362 in East Park Add, to town of Haubstadt
� Name m property tax records if different from above?
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,.7. 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 valuc �:; :�.c: estate as of March 1, current year o �3 �- a9��o
A Amount oC Mor�_.:�^ ur ContraM Indebtedness unpaid as of Mazch 1, current year $ 19� 842. 36
; Drawer 4
�. D7ortgage ar Conc�:.� recorded G 1}JSOII County Recorder's Office, Record No. _
u�Name and addr... .,f mortgagee or contract seller Haubstadt State Bank
w�Do you know if there is any assignee or bona fide owner or halder of the mortgage ar rnntract? Yes
� what is the name and residence? ���
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No If yes,
z Does the owner of the above described rea] property own real property in any other County in the State ot Indiana?
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Yes No It yes, what County and Tarzing District?
Has this deduction been requested on that property for the current year? Yes � No
Amount Allowed
°1�t-ba G��1/99 r�Cw
COUNTY BOARD OF REVIEW
ACTION
APPROVED IN AMOUNT OF S�1�.0���.P,
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REMARKS
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