HomeMy WebLinkAboutMortgage_MorrowForm 5 Reai�ed 1%1
Prtacribed by Ne Stao- Bon+d of Taz Commis+ioom
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CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
TO BE F7LED IN PERSON OR BY MAIL IN DUPLICATE EACH YEAR BY THE OWNER WITH THE COUNTY AUDITOR
"pN WHICH THE PROPER7'Y IS LOCATED) BETWEEN MARCH 1 AND MAY 10. INCLUS[VE
T� (6-1.1-12-1 THROUGH 6-1.1-12-B)
^•QUALIFICATIONS ON BACK°• � � o�
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_ STATE OF INDIAN� �� COUNTY, ss: /
F51ing Fx SI.W
� I. (We) �
(FUIL . AME�
certify that [, (We)'was/were legal resident{s) of the St of Indiana and owner(s) of real property on March 1, 19 ��and that this
statement is made for the purpose ot obtaining a deduction fiem that real property Ixated in Taxing District (City, Town, Township)
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Described W wi[:
Legal Description/or Key Number �� / / ,°� � � (/%� /�O � �/� �' 's � /TC
� Name on property taac recards it ditferent from above? /—� —/ O �-�S� �C
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Z Are you the sole legal or equitable owner of the real estate? Yes No
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GQ �
a If no, what is your exact share of interest in it?
� Assessed value of real estate as of March 1, cuaent year � �
� Amount ot Mortgage or Con[ract Indebtedness unpaid as of March 1, current year S�� ✓ �
�� \iortgage or Co�cract recorded Cwnty Recorder/J's O�ffic�e,, /RJecord No. � Page O V°�
Name and address of mortgagee or contract seller �i �'-�� � �/�'��
WDo you know if there is any assignee or bona fide owner or holder of .the mortgage or rnntract? Yes A'o If yes,
� what is the name and residence? �� �� �"'
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� Ilnna the nwner of the above. described real uroperty own real property in any other County in the State of Indiana?
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Yes No If yes, what County and Taxing Dis[rict?
Has this deduction been requested on that property for the curt�t year? Yes
Amoun[ Allowed
ACTION
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REVIEW
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'See False Statement Penalty Below
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' SECftETARI' OF BOARD
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10 �ER'S FUIL I:AMEI
IPER50\ AU'fHORIZEII BS DULY E%EC PoWER OF ATIDR\EY�
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INLL RESIUE�CE AD�ftP55 OF OM�ER — MUSt BE G�� �oo
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IADOftE55 OF AVI'NORIZED PERSOA)
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