HomeMy WebLinkAboutMortgage_Caniff (4)Form 5 Re•isN IA.�D _ Nine Fm SLl•1
Prescribed bv Ne Sum Board o( Tea Commissionm
CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS �
TO BE FILED IN PERSON OR B5' MAIL t\ DUPLICATE EACH 1'EAR B5' THE OK'NER H'ITH THE COUNTY AUDiTOR
pN WHICH THE PROPFRTS' IS LOCATEU) BET�PF,EN MARCH 1 AND MAY 10, INCLUSIVE
I �,��'1/� (6-I.L12-1 THROUGH 6-1.1-t2-8) [/� ["
R� ola-n��f � (/`/ •••Qu�LIFICATIOVS ON BACK••• 3—�!
I
STATE OF INDIANA ��6� COUNTY, ss:
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l�?� �
�, �we>. , a �,..�,
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certify [hat I, (We) �ras/w�ere legal resident(s) of [he State of Indian nd owner(s) of real property on blarch l, l9 — and that this
statement is made for the purpose of obtaining a deduction from that real propeRy located in Taxing District (City, Town, Township)
Described to wit:
Legal Descrip[ion/or Key Number�o-�,� 1'\����`�""''"�
� Name on property tax records if diCferent from above?
z
.,
A
Z, Are you the sole legal or equitable owner o( the real estate? Yes �, No
� �, ` "'
� If no, what is your exact share of interest in it? �
OAssessed value o( real estate as of March��rre �
� Amount of nSortgage or Contract Indebtedness unpaid as of Dfarch 1, current pear $ �.���1.0�
�•� ilorigage recorded �-�-u-�-� "' County Rernrder's Office, Record No. y Page �3
' ^`J .
� Name and address of mortgagee or con[ract seller\ �+ �
� Do you knoa i( there is any assignee or bona fide owner or holder o( [he mortgage or rnntract? Yes No __�_. If yes,
�what is-the name and residence? � 9a - � a o G�!
a a�,,�
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IDoes the owner of the above described real property own real property in any other Coun[y in the State of Indiana?
Pes No �— If pes, what Coun[y and Taxing District?
Has this deduction been requested on that propertp for [he cunent year? Yes , Yo _� �6/%f
i�
Amount
COUNTY BOARD OF REVIEW
APPR����''' ACTION
D� �M U�ON S —
3 REMARKS �
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'See False Statemen[ Penalty Below 6�
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iF'ULL R�IDF.SCE AODRF_SS OF ON'�F.N —]NSI' BE GI\'F.\�
09
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SECRF.TANS' OF eOAXD ��0 �� �� ��� la�>�1RE�5 OF AVfHOR12F.D PERSOYI
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