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CERTIFICATE OF MORTGAOGE�� CONTRACT INDEBTEDNESS •
TO BE FILED IN PERSON OR BY MAIL IN DUPLICATE EACH YEAR BY THE OWNER WITH THE COUNTY AUDITOR
(IN WHICH THE PROPERTY IS LOCATED) BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
� (6-11-12-1 THROUGH 64.1-12-8) �
°•QUALIFICATIO\S ON BACK°' / ' DO
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STATE OF INDIANA •� �l���� vCOUNTY, ss:
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certify that [, (We) was/were legal resident(s) of the Sta of Indiana and owner(s) of real property on March 1, 19 �"Q and that this
statemen[ is made for the purpose of obtaining a deduction from that real property located in Taxing Dis[rict (City, Towq Township)
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� f/�/�'LC-�'Y�. Described to wit
Legal Description/or Key Number / /�'�t- �' 3�� � a,L�-
Name on property ta:c-records if difterent Crom above?
Are you the sole legal or equitable owner of the real estate? Yes
If no, what is your exact share of interest in it?
No
Assessed value of real estate as oCMarch 1, current year �3 /O" / 7oZ00= �Os7p
AmounLof Mortgage or Contract [ndebtedness unpaid as of March 1, current year S 36 • DA i) ��I-��y "��
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I�7ort�age or Contract recorded �� County Recorder's O(fice, Record No. � Page ��LL__
Name and address of mortgagee or contract seller '
Do you know if there is any assignee or bona fide owner or holder of the mortgage or mntract? Yes —, No If yes,
u•hat is the name and residence? 0� D� O� O� O�
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described real property own real property in any other County in the State of Indiana?
Yes __�YNa �'_,1! —V It yes, what County and Taxing District? � �
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Ha�f.hi� i d on:that property far the current year? Yes No �
AUDITOR h p�I
Amount Allowed ��/� ��+ �(���
I�'GlGI !3 ,� �-�i�D� �°��
BOARD OF REVIEW 'See False'Statement Penalty Below
ACTION �., iI/,!R' �
X IOH'NER'S GIL 1AD1�
APPROVED IN AMOUNT OF$
� REMARKS
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�PERSO\ AUTHORIZED 9Y DULY EXECVfED POWEft OF A'f'IOR.tiEY1
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(PULL RFSIDE ' E A DRGSS OF ON'\ER — MUSf BE GItlE.Y)
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(,�DDRFSS OF AIRHORIZED PER50\)
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