HomeMy WebLinkAboutMortgage_Utley (2)' Form 5 Aevieed t931
Presenbed by iL<State Boa'd of Tez Commiasionvn
•CERTIFICATE OF MOR7
TO BE FILED IN PERSON OR BY MAIL IN DUF
��(IN WHICH THE PROPERTY IS LOi
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oSTATE OF INDIANA _
I, (We) —,��=� � � l . �1- �
. . FilivR Fes SI-00
�O� � �
OR CONTRACTINDEBTEDNESS
�ACH YEAR BY THE OWNER WITH THE COUNTY AUDITOR
TR'EEN MARCH 1 AND MAY 10, INCLUSIVE
UGH 64142-8) /
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COUNTY, ss:VI o°
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certify that I, (We) was/were legal resident(s) o the State of Indiana and owneKs) of real property on March 1, 19 � and that ihis
statement is made for the purpose of obtaining a deduction from that real property loc�ed in Taxing District (City, Town, Township)
Described to wit:
Legal Description/or Key Number �� •�/a ��' �� �
� Name on property tas records if different from above? 6�^�J �,p —'"'I ��
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�. Are you the sole lega] or equitable owner of the real estate? Yes � No
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a If no, what is your exact share of interest in it?
� Assessed value of real estate as of March 1, current year � �`� ' 3� o�
� Amount of Mortgage or Contract [ndebtedness unpaid as of Mazch 1, current year S «����
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. �;`� foRgage or Contract recorded
i� e and address of mortgagee or contract seller
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County Recozder's Office, Record(' �No. —1_ Page �5"'O
6n�� Lr-/�.lQ%�° � NMC- .
W Do you know if there is any assignee or bona fide owner or holder of the mortgage or contract? Yes � To It yes,
Qwhat is the name and residence?
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� Does ey,-of ��2�described real property own rea p ' any other County in the State of Indiana?
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Yes , d� � what County and Taxing District?
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Has this dea�xbc�bee'�uested on that property for the cunent year? Yes � No ��b�
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Amby�pt
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�OARD.OF REVIEW..
ACTION
APPROVED IN AMOUNT OF S
A.
SECREfARY OF BOARD
DATE
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'See False Statement Penalty Belaw
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V � ' ` �OW�ER'S NIL �ANEI
O/ +J�A1 O � l�-�DU� I ��WEI/"`�'� �!`-a
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IFULL ftFSI RCE ADDRCSS Of OW\Eft — MUST 8E GIVE6�
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(ADURESS OF AVI'NO D PER50��
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