HomeMy WebLinkAboutMortgage_BraseltonFwm.iRe.isd I9E1 � . �e Pee SI.W
Peescribd b�' �he Siew Boeed o! Taa Commissionerz
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CERTIFICATE OF MOIiTGAGE OR CONTRACT INDEBTEDNESS �
. ' TO BE FILED IN PERSOti OR BY MAIL IN DIIPLICATE -EACH YEAR BY THE OWNER R'ITH THE COUNTY AUDITOR
(IN WHICH THE PROPERTY IS ISOCATED) BE7'WEEN MARCH 1 AND MAY 10, INCLUSNE`� , � .
� , (6��.142-1 THROUGH 6•1.L12-8) � �' .�
� , ^•QUALIFICATIONS ON BACK°• O��
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,
resident(s) of the State of Indiana and 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 Dis[ri..c.jt (C�ity,, Town, Township)
' � � " Described to wit:
Legal Description/or Key Number V �� ���` °'�'� �� � �'�' °2•� �
� Name on praperty taac records i( difterent from aboce?
z
�
A
z Are you the sole legal or equitable owner.of the real estate? Yes � No
rti
� If no, what is your exact share of interest in it?
� Assessed value of real es[ate as of March 1, current year ____I�������
7 J ���
�� . Amount of Mortgage or Contract Indebtedness unpaid as of March 1, current y�\��1X 1. �
�, Diortgage or Contract rewrded County Recorder's Office, Record No. � Page � ��
Name and address of mortgagee or contract seller �� �• �+�"
WDo you know if there is any assignee or bona fide owner or holder of the mortgage or rnntract? Yes
Qwhat is the name and residence? �
� �
�
No It yes,
z Does the. owner of the above described real property own real prope y in any other County in the State of Indiana?
r-i
� Yes I�o —
�
If yes, what County and Taxing District? � p�-� � '
. � � �
Qi Has this deduction been requested on that property (or the current year?:]'es No � 9}ggg�
(/2 Amount Allowed —
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z COUNTY BOARI7"OF REVIEW
,.., ACTION
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APPROVED IN AMOUNT OF $ �
3 REMARKS � �� ���`
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A
SECRETARY OF BOARD
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� ��n � /�,,� / •�_ , _ .-� n „ �
� -� �- �� � - , v •AUDITOR ���o�'�" �,
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. 'See False Statement Penalty Below
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UDORESS OF AVI'HORIZED PER50S) .
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