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Prescribed by Ne Su'e BoeN o( Ta: Commiasio�e» O Q� O
CERTIFICATE OF MORTGAGE O�NTRACT INDEBTEDNESS � 0`�� pO
TO BE FILED IN PERSO IN DUPLICATE EACH YEAR BY THE OWNER P'ITH THE COUNTY AUDITOR
. 1iN- ' CATED) BETR'EEN MARCH 1 AND MAY 10, INCLUSIVE �
� 12-1 THROUGH 6-1.1-12-8)
�l' D LIFICATIONS ON BACK^• - +
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certify that I, �SVe) was/were legal resident(s) of the State of Indiana and owner(s) oi real property on March 1, 19 ��iid that this
statement is made for the purpose of obtaining a deduc[ion from that real property located in Taxing District (City, Towq Township)
Legal Description/or Key Number
� Name on property tax records if different from above?
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x. 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?
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� Assessed value of real estate as of March 1, current year �°'�"° �
�� . Amount of Mortgage or Contract Indebtedness unpaid asrof �larch 1, cunent year $ Q�fl
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�7ortgage or Contrac[ recorded
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�� Name and address of mortgagee or contract seller
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County Recorder's Office, Record No. � Page � O� �
W Do you know if there is any assignee or bona fide owner or holder of the mortgage or�rnntraM? Yes No ' [f yes,
Qwhat is the name and residence? � I�� o��� �
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zDces the owner of the above described real pmperty own real property i❑ any other County in the State of Indiana?
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� Yes �•No If yes, what County and Taxing District? --
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Qi Has this deduction been requested on that property for the current year? Yes No �
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(f� Amounc Allawed " � b� '�/� �i� �'� n . fl--
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z COUNTY BOARD OF REVIEW
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Ey APPROVED IN AMOUNT OF $
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SECRETARY OP BOARD
DATE
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��°� 9- � � JUL 0; i98B
'See False Statement Penalty Below
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�PER �UTNO ED BY UUJ.�EXECVfED POWER OF ATTDRT"EYI
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iFULL ftFSIDE\CE A D OF ON'NER — MUST BE GIVE')
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�ADURFSS OF AUTNORIZED PEELSO\) '
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