HomeMy WebLinkAboutMortgage_Martin (6)Rling Fa SI.00
Form n flevieed 19fi1
PrenviMd by tlie Sta`e Bon�d of Tez Cammiseioom �/C1/ /��
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CERTIFICATE OF MORTGAGE O ON R NDEBTEDNESS
TO BE FILED IN PERSON OR $Y MAIL IN DUPLICATE EACH TH WNER WITH THE COUNTY AUDITOR
� "(IN WHICH THE PROPERTY IS LOCATED) BE'fWEE ARCN 1 AND MAY 10, INCLUSNE
, (611-12-1 THROUGH 6-1.1•12-8) n
^�� •••QUALIFICATIONS ON BACK•^ 3 _.. �
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STATE OF INDIANA
COUNTY, ss: f �O
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certify that I, (1Ve) was/were legal resident(s) of the State of Indiana and owner(s) of real property on March�l
statement is mad/e� for the purpose of obtqining a deduction frorty that real propepty located in axing District
if" � %t ,Y G %� bj YI � �-;( .J � �,r! �/.ix..c�.--
19 Q� and that this
City, Town, Township)
Described to wit:
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Legal Description/or Key Number � �� � � � a �a �
I� Neme on pmperty tas 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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i� If no, what is your exact share of interest in it? ,�� '� -- �
� O 1- �; � _, _ � �!I ll�no; —/��.00�ZS�Po
�y Assessed value of real estate as of March 1, cunent year ' �-��
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�~ Amount of Mortgage or Contzact Indebtedness unpaid as of March 1, current year S
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�y�ortgage or Contract recorded ��� County Recorder's Of c
��' Name and address of mortgagee or contract seller �-
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I�� you know if there is any assignee or bona fide owner or holder ot the mortgage i
� � h� me � ce? � � �
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300
R�o. �-�' Page
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z Does [�'E '6wner of `�Re above described real property own real property in any o[her County in the S[a[e of Indiana?
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tj tieB s, what County and Taxing District? - ^� �
� AUt�ITOR r_����t�
Q Has this deduc6on been requested on that property for the current year? Yes No J �
' (/� Amount Allowed
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COUNTY BOARD O� REVIEW •See False Statement Penalty Below
,,z,, ACTION 3 p
--'��-"-- ��`%'� �pµ;�--�%'�ER'S FUIJ. SAMEI ` .
3 i5 89
APPROVED
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A � � AUDITOR
SECRETARY OF BOARD
DATE ;�s��—
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�PERSOS AUTNORIZED Bl' UULY XECUTED Poµ'ER OF ATfOR\El}
�Fll� O RE55 OF ON:CER — M� ��I
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�ADDRFSS OF AVI' IZED PEIt50S)
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