HomeMy WebLinkAboutMortgage_RuckmanForm 5 Reri d 1981 . �/� . Fi1�n8 Fee SI.00
Preacribed by Ne Smu BoeN of Tax Camm'vsianm (�
CERTIFICATE OF MORTGAGE O�CDONTRACT INDEBTEDNESS
TO BE FILED IN PERSON OR SY MAIL IN DUPLICATE EACN YEAR BY THE OWNER WITH THE COUNTY AUDITOR
-(IN WHICH THE PROPERTY IS LOCATED) BETR'EEN MARCH 1 AND MAY 1Q INCLUSIVE
� (6-1.1-12-1 THROUGH 6-1.1-12-8)
•"QUALIFICATIONS ON BACK"' ��-
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� STATE OF INDIANA �� COUNTY, s���0
I, (We) y����'�_-��J'�2l���LJ �
IF Il \A IEI
�certify that I, (We) was/were legal resident(s) of the State of Indiana and owner(s) of real property on Mazch 1, 19 � that this
statement is made for the purpose of obtaining a deduction from that real property located in Taxing District (City. Town, Township)
Legal Description/or Key Number
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Described to wik
� Name on property tax records if differentirom above? �
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.7..� Me you the sole legal or equitable owner of the real estate? Yes T;o . vl 1- 5.3�a
" sO° - 0
� If no, what is your exact share of interest in it? — ��
� Assessed value ot real esta[e as ot Dlarch 1, current year
� Amount of Mortgage or Contract [ndebtedness unpaid as of March 1, current year S/1 b(�f% ?—
� Mortgage or Contract recorded /✓ //�t� County Recorder's Office, Record No. � Page _/ � C
� � A /�
W Name and address of mortgagee or contract seller ���� �� f� �J�_�
��Do you know if there is any assignee or bona fide owner or holder ot the mortgage or contract? Yes No If yes,
U�what is the name and residence? �� b"
Q
� 9�r��,1 l� 01 �`�� l�% P ��—
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z Does the owner ot the above described real property own real property in any other County in the State of Indiana?
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(j Yes _—� No It yes, what County and Taacing District?
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Q Has this deduction been requested on that property Cor the curzent year? Yes No
Cfj Amount Allowed � � 0�
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�COUNTY BOARD OF REVIEW 03 �, •See False Statement Penalty Below
� ACTION b.a- ��0
(y APPROVED IN AMOUNT OF $ -� �� � ��' ` ��a.�.`�
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OF AITI'HOAIZED PERSO\)
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