HomeMy WebLinkAboutMortgage_Smith (26)�
Form 5 Revieed I951
Filing Fce f1.00
Pma�nbed by �he Suu Boerd of Tax Cammiuiovere �� ��� �
CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
TO BE FILED IN PERSON OR 8Y MAIL iN DUPLICATE EACFi YEAR BY THE OWNER WITH THE COUNTY AUDTTOR
�QN WHICH THE PROPER7'Y IS LOCATED) BETR'EEN MARCH 1 AhD MAY 10, INCLUSIVE
(8-1.1-12-1 THROUGH 6-11-12-8) '^
"'QUALIF7CATIONS ON BACK°' J � `�
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STATE OF INDIANA �9�� COUNTY, ss: /�
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(FUIL YAMEI (y.�
certify that I, (Ne) was/were legal resident{s) of the State of Indiana and owner(s) of real property on March 1, 19 �_pt. and that this
statement is made for the purpose of obtaining a deduction from that real property located in Taxing District.(City, Town, Township)
` �+• /�\ Described W wit:
L.egal Description/or Key Number
� Name on property ta�c records if different from above?
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,Z Are you the sole legal or equitable owner of the real estate? Yes No
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� It no, what is your exact share ot interest in it? ��=��
� Assessed value of real estate as of March 1, current year ��` '� � �-
� Amount of Mortgage or Contract Indebtedness unpaid as of March 1, current year S ��/�
��Nortgage or Con[ract recorded County Recorder's Office, Record I�
� Name and address of mortgagee or contract seller �����C�` �"� �1��'^'�'
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W•b you know if there is any assignee or bona £de owner or holder of the mortgage ar mntract? Yes
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iQ what is the name and residence? OaJ
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No
If yes,
z Does the owner of the above. described real property own real property in any other County in the State of Indiana?
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(�j Yes No If yes, what Countp and Tarzing District?
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Q Has this deduction been reques[ed on that property for the current year? Yes No
(J] Amount Allowed
x
F COUNTY BOARD OF REVIEW
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(.Wy APPROVED IN AMOUNT OF S
3 REMA�I S R T ��
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�' ��See False Statement Penalty Below
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IPEPSO� AITTFiORIZED 6Y WLY E%EC�TED PoWER OF ATTDR.YEY�
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(FULL ' I E\C AWRF_SS OF OM�ER — MUSf BE GIVES�
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j ARY F BOARD �J^+ � /_ I• �� /J. (AU RFSS OF AVI'HORIZED PERSOY)
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DATE "]'��"`yJ [/'�' _ - _