HomeMy WebLinkAboutMortgage_Campbell (3)Fwm i ile.ised 14:1 O O FS��ef Pee SI-00
Pmcnbad by �he ��a`e Bmed of Tea Commissianers J� � � c'
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� CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
TO BE FILED IN PERSON OR BY MAIL IN DUPLICATE EACH YEAR BY THE OWNER WITH THE COUNTY AUDITOR
. QN WHICH THE PROPERTY IS LOCATEDI BETR'EEN MARCH 1 AND MAY .
(61.1-12-1 THR GH 6-1.1-12-8) ��
'•'QUAL[FIC NS ON BACK••• � A � �� a
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�/� STA�E O� IpF�IA�TA /; i ^ CO^N�Y�s�J ,/
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certify tha[ I, (We) was/were lega]
statement is made for the purpose
Legal Description/or� Key Number
the State of
a �deduciion
� \ame on property tax records if different from aboce?
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�., Are you the sole legal or equitable owner of the real estate? Yes
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I( no, wha[ is your exact share of interest in it?
and owner(s) of real property on March 1, 19 L(land that this
ity�l property located in Taxing District (City, Tawn, Township)
No
Described to wiL
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� . Assessed value of real es[ate as of D7arch 1, curtent year � 9—�.,7 6 a
� Amount of Mongage or Contract Indebtedness unpaid as of March 1, cuaent year S � O O �
� � Mortgage or ConVact recorded � County Recorder's ice, Record No. v age���d
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�, Name and address af mortgagPP �* ���trrrt c�ll�r )
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WDo you know if there is any assignee or bona fide owner or holder of
Qwhat is the name and residence? -
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Does the owner of the above described real property own real property in
Yes No If yes, what County and Taxing District?
Has this deducGon been requested on that property for,tt�yRrent year? Yes
Amount Allowed
COUNTY
REVIEW
ACTION
APPROVED I1 AMOUNT OF S L� � ��
REMARKS O
SECREfARS' OF BOAAU
or contract? Yes No If yes,
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any other��y in ��of Indiana?
iVIAR 2 % 1990
No
�gpSt � AUDFTOR �
�l� 'See False Statement Penalty Below �00� / ��
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pR'YER'S FUIL RAA 1
,�� !` IPERSO\ AU'i'FIORIZED BY DULY E%ECVI'ED POWER OF ATNR.\EY�
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/' ��`��Th�A n^�"� '�- V�'
( (FULL RFSIOEFCE ADDRFSS OF OH'NER — MUSf BE GIVE\� .
II 6-��-58
DATE
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- IAODAE55 OF AVI'NORIT&D PEAO\�
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