HomeMy WebLinkAboutMortgage_Jochim (6), �
Form � Reaisd 19�1
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Prescnbed by Ne Su�e BoeN of Tex Commissiona<
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CERTIFICATE OF MORTGAGE OR 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 MARCN 1 AND MAY ]0, INCWSIVE.
(8-1.1-12-1 THROUGH 6-11-12-8) � � '
"'QUAL[FICATIONS ON BACK^•
V �STATE OF INDIANA �---�-�, COUNTY, ss: 1
I, (Ne)
1 LL \A 1
tertify that I, (Ne) was/were legal resident(s) of the State of Indiana and owner(s) af 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 District (City, Towq Township)
Described W wit:
Legal Description/or Key idumber ����,,�� I U � l�y-3-l� -`l��_
�- Name on property tax records if different fmm above? '�
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,� Are you the sole legal or equitable owner of the real estate? 1'es 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, wrrent year
� Amount of Martgage or Contract Indebtedness unpaid as of Mazch 1, wrrent year S�
� Mortgage o��c�� County Recorder's Office, Record
II�PY..�t ��
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Page
� Name and addres of mo or contract seller M'� � I\�'�--i, • v
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W Do you know if there is any assignee or bona fide owner or holder of the mortgage or contract? Yes No
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Q what is t e nFi' "ame����� ! O _
If yes,
Qi
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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 County and Taxing District?
Q Has this deduction been requested on that property for the current year? Yes No ��
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(f� Amount Allowed �
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z COUNTY BOARD OF REVI�
,.., ACTION
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�(.Wy APPROVED IN AMOUNT OF S �v �'
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3 REMARKS U �
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SECftETARI'OF BOARO
DATE
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� � IPEIt50\ AUTFiOftIZED BY DULY E%ECUTED PoN'ER OF A7'IVR.\EY�
�� �FULL RFSIOENCE AUORCSS OF ON:\ER — MUST BE GIYEY)
(ADDRZSS OF AUTHORIZED PER50\�
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