HomeMy WebLinkAboutMortgage_SmallFmm 5{te.iad IA�I Fil'wg.Fee SI.00
Preuribed by the Smre BoaN a( Tex Comm'aaianm O O^ ��
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CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS •
TO BE F[LED IN PERSON OR $Y MAIL iN DUPLICATE EACH YEAR BY THE OWNER WITH THE COUNTY AUDTTOR
��pN WHICH THE PROPERTY IS LOCATED) BETR'EEN MARCH 1 AND MAY 10, INCLUSNE �
(61.1-124 THROUGH 8-I.1-12-8)
. '°QUALIFiCATtONS ON BACK••• /��
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STATE OF INDIANA � COUNTY, ss:
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I,�(�Ve) O'�'✓Y�� l� X- � a�c-n-r-es-n- -/YLa.F,L.
IFUIL NAME�
mrtify that I, (Ne) s/were legal resident(s) of the State of Indiana end owner(s) 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, Tawnship)
�'t � `�-� Described to wit
C,egal Descriptian/ar Key Number ��� �hd-� l•�-�C- . �
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Name on property tax records if different from above? �
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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 ot interest in it?
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Assessed value of real estate as ot March 1, current year
Amount of Mortgage or ContraM Indebtedness unpaid as of Mazch 1, current year $ 3�r / O'�. ST
b1ortgage or Contract recorded /✓+�L County Recordez's Office, Record No. � Page ��
Name and address of mortgagee or contrac[ seller ���� `� "�'i"� " `� �`�-�-r-�J
Do you know if there is any assignee or bona fide owner or holder of the mortgage or rnntract? Yes � No If yes,
what is the name and residence?
z Does the owner ot the above- described real property own real
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� Yes No If yes, what Caunty and Ta�cing District?
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d Has this deduction been requested on that property for the curtent year? Yes No
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(� Amount Allowtd
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F COUNTY BOARD OF REVIEW
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-REMARKS
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property in any other County in [he State of Indiana?
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IPERSO\ AUTHOftIZED BY DULY E%EClfl'ED PON'ER OF ATICIR\El"1 Q
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IFULL RESIDEFCE ADDRFSS OF OWFER — MUSf BE GIVEN�
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SECREfARY OF BOARD �� /��s.... n IAODRF55 OF AVI'HO D PER50�)
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DATE �' 9�� � ��