HomeMy WebLinkAboutMortgage_HarmonForm 5 Rni�ed 1!k0
FilinR fm bLLn
Prombad br Ne Smm Board af Tax Comm�sswnees
CERTIFICATE OF MORTGAGE OR CONTRA�N�BTE�NESS
TO BE FILED IN PER50\ OR BY MAIL 1\ UUPLICATE EACH YEAR B5' THE Ow'NER N'ITH TNE COUNTY AUDITOR
(IN R'HICH THE PROPERTY IS LOCATF.D) BETR'EEN MARCH 1 AND MAY 10. INCLUSR'E
16-1.1-12-1 THROUGH 6-1.1-12-8) �
�� "•QUALIFICATIONS ON BACK••• �—
STATE OF INDIANA �r�.�:C1�� COUNTY, ss: //lIrli
�(f(lC/
� I. (We) �cx'vr�s�V �,\1`�efY L�•.J w-c7CSi�r�c�. . �i_
�F�uu. .nme�
certify that I, (�Ve) was/w�ere, legal resident(s) of the State of Indiana and ow�ner(s) of real property on March 1, 19� � and that this
stacement is made for the purpose of obtaining a deduction from that real property Iocated in Taxing District (City, Town, Township)
� t� �(�_('�� � Described to wit:
Legal Description/or Key Number
� Name on property ta�c records if different from above?
z
�
A
x. Are you [he sole legal or equitable owner of the real estate? Yes �_, No
1�
� If no, what is your �exact share of interest in i[? �
� Assessed value of -real esta[e as of March 1, curren[ year �����// `����-^� O
L
� Amount of Mortgage or Con[ract Indebtedness unpaid as of hiarch 1, cunent year S�000• "`�'
�61ortgage recorded ��-���� County Recorder's Office, Record No. ��03 Page�a3
�
W •- p � .
� Name and address of mortgagee or contrac[ seller�s �M ��� ��✓hn K('T 'Sl�:n.t�:XC�'i�
�� Do yw knoa iC there is any assignee or bona fide owner or holder of the mortgage or contract? 1'es No �. If yes,
what is the name and resideoce? (J� �"�
a ���
zDoes the ow•ner of the above described real proper[y ow�n real property in any other Coun[y
H
�j Yes �\o —�— If yes, what County and Taxing District?
�
Qi Has this deduction been requested on tha[ property for the cunent �ear? Yes No —�—
�
in the State of Indiana?
(f1 Amount Allowed : �' Q � � � �V /
F � � � b°��°� B ��� �� � � 7
COUNTY BOARD OF REVIEW �� � �See False Stacement Penalty Below Q� � �
„z,� ACTION Q$
W �F.+
Ey APPROVED IN AMOUNT OF S Q
� h � i � t� �j r
REMARKS'� �� '
,� . ; �. �-r p �L
��
� P,PR _��$9-�
o p (k =. � .
� ���� �ox�\crs�; ruu. anHe� i
�PEF_iOS AUIHORiZED Rl' DULI' EIEC�TEU POH'ER OF ATIOR\'Ell
� l u � 5. �-U,.�.�� ,4-�•
�FULL ftLiUE\CE ADDRGSS OF ON'�Ep — MUST BE GIYEU
� - �'�.�- .�� ,�
�— SEI�F.T� OOF Bl'� �� �G '" L- C! •" AD�RF_55 OF AVfHORIZEU PER50�1
7- 9- 98 - ''�c �e ' -
DkTE - —