HomeMy WebLinkAboutMortgage_Wilbert Burial Vault of Ft BrForm S Revised 1991 O � Q FV�n6 FN SI.00
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CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
TO BE FILED IN PERSON OR 8Y MAIL IN DUPLICATE EACH YEAR BY THE OWNER WITH THE COUNTY AUDTTOR
-(IN WHICH THE PROPERTY IS LOCATED) BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
(El.1-12-I THROUGH 6-1.1•12-8) q
- '••QUALIFICATIONS ON BACK•'• _/ /� �
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STATE OF INDIANA �—� / COUNTY, as. � O�
(We) `�`� � V � . /�--s-s�-�% .e.�`
(FUII. NAME�
<erti(y that I, (We) was/were legal resident(s) ot the State of indiana and owner(s) of al property on March I, 19 -- and that this
statement is made for the purpose of obtaining a deduction from that real property located in Taxing District (City, Town, Township)
Legal Description/or Key Number
� Name on property taY records if di(ferent trom above?
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,Z 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 of interest in it?
� Assessed value of real estate as of March 1, current year Q �
� Amount of Mortgage or Contract Indebtedne�as of March 1, current year S
� �.oRgage or Contract recorded
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� Name and address of mortgagee or contract seller
� Do you know if [here is any assignee or bona fide owner
a�•hat is the name and residence?
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County Recarder's Office, Record Na.
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of the mortgage or rnntract? Yes
Described to wit:
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� No If yes,
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Does the owner of the above. described real pmperty own real propeRy in any o[her County in the State of Indiana?
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(,�j Yes no If yes, what County and Taxing District?
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Q Has this deduction been reques[ed on tha[ propedy for the curtent year? Yes No
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C/� Amount Allowed -
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,z COUNTY BOARD O W �� a 5'�' 'See alse Statement Penalty Below �
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APPROVED IN4�70PIP1�OF S —
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A SEGRFTARY OF BOAftD
ATE
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� � � " IOWI:ER'S FULL \A?tE
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/�� �PE \ pU'fFiORIZED Bl' DULS" EXECVI'EO PoN'ER OF ATT/ORy\El'1
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(FU UE\C�FSS OF ON" �R — MIIST BE GIYE1�
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IAOORESS OF AUTHORIZED PER50�1
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