HomeMy WebLinkAboutMortgage_CarterForm i Re.i.red 19r1
Prescribed by �he Siam HoeN of Ta. Commiss�oners
�R Fce 51.00
L�
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
QN R'HICH THE PROPERTY IS LOCATED) BETWEEN MARCN 1 AND MAY 10, INCLUSIVE
� � ��/ D� (6-1.1-12-1 THROUGH 6-1.1-12-8)
.. Q�� I oO � •••QUALIFICATIONS ON BACK••• / O 1O
� �� V / 0
STATE OF INDIANA `•��-�•�G.e+ti� COUNTY, ss:
I, (\Ye)
�
U�.... ......._.
certify that I, (\Ve) was/were legal resident(s) of the Sta e oC Indiana and owneds) of real property on Mazch 1, 19 _��and that this
statement is made for the purpose of obtaining a deduction.from that real property located in Taxing District (City, Town, Township)
/ � .
��1'�� Described to wit:
Legal Description/or Key Yumber SS � T��
� Name on property tazc records if difterent from above? �
z -
�
A
,Z - Are you the sole legal or equitable owner of the real estate? Yes A'o ' �
H
:Q
� If no, what is your exact share of interest�in it?
OAssessed value of real estate as of March 1, current year 3�� ��' 3 sd
� Amount of Dlortgage or Contract Indebtedness unpaid as o( March 1, current year S °�'� � �
� D7ortgage or Contract recorded � County Recordei s Office, Record Yo. � Page 3�i O-1
s .�y� �(�� Q- ,�.� o
� Name and address of mortgagee or contract. seller !���[.��" ="'�' �LiM�,
� Do you know if there is am� assignee or bona fide owner or holder -of) the mortgage or rnntract? Yes
Q wha��n me�i re,'�ce? v V ���
Q�i
� a �1 _ , �
� iJ1A � /
Does the own z� of the v escribed real property own. real property
�
C� Yes �`' • O�P�(�J ,���. yes, what County and Taxing District?
Rr'
Q Has this deduction been requested on that property for the cuaent. year? Yes
� ,
!/� Amount Allowed
H
F � a l .
z COUNTY BOARD OF REVIEW
� ACTION
W APPROVED IN. AMOUNT OF S�
3 REMARKS ��
�
z
o�
_�
� — SBCRETARI'OF BOARU ' ^ —
JA
No If yes,
in any other County in the S[ate af Indiana?
No
40 t-
-/9-D2
�, �S-O`/ v� '���
'See False Statement Penalty Below - '
-�o� ,� r��� �°��.��
IOM'6ER'S FUIL SAME)
�7 IPEH50� AUTHORIZED BY .' E%ECUTEU POWER OF ATTDR,\EY�
� _�o SO /��rJG-�
( ULL RFSIOESCE ADDR�55 OF ON'SEft — MUST BE GIVEY)
°�� -���- ,� ���
IADORE55 OF AUT�NfORIZED PERSO�)
/'1 �')