HomeMy WebLinkAboutMortgage_Collins (8)Form i Rerived IA�1 � . F51ioe Fes SIDO
PrescriMl by �he Suie e�rd a(Taa Commissianers
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CERTIFICATE OF MORTGAGE" OR CONTRACT INDEBTEDNESS
TO BE FILED IN PF.RSO\ OR BY MAIL IN DUPLICATE EACH YEAR BY THE OWNER WiTH THE COUNTY AUDITOR
(IN R'HICH THE PROPERTY IS LOCATED) BETR'EEN MARCH 1 AND MAY 10, INCLUSNE
� (6-1.1-12-1 THROUGH 8-1.1-12-8)
� °•QUALIFICATIONS ON BACK^' / � O O�
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I. (We)
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STATE OF/ INDIANA h-rxJ COUNTY, ss:
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certify that I, (We) was/were legal resident(s) of the State of Indiana and owner(s) of real property on March 1, 19 � 0_ and that this
statement is made for the purpose of ob �ing a deduction from that real property located in Taxing District (City, Towq Township)
�/��f+e��4'x� Described to wit
Legal Description/or Key A'umber r� �SL� /T ���'� � '��
� Name on property tas records if different fmm above? `
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�. Are you the sole legal or equitable owner of the real estaCe? Yes No
ry
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� If no, what is your.exact share of interest in it?
OAssessed value of real estate as af March 1, wnent year � ��� ��� �� = �� � �
� Amount of Dlortgage or Contract Indebtedness unpaid as of March 1, current year S ��O 0�'
�' S ,�579
A7or[gage or Contract recorded �� County Record/er's Offce, Record No. Page
^� Name and address of mortgagee or contract seller ��� N`�(�CqC� �/�-v
WDo you know if there is any assignee or bona fide owner or hoYder of the mo ge or contract? Yes No If pes,
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Q what is the name anq�,r,es� n ��
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z Does the owner ; of the above es i real pmperty own real property in any other County in the State of [ndiana?
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(} Yes no O' �� y and Taxing Dis[ric[?
Q Has this deduction been requestedOR at property tor the cunent year? Yes No
(J? Amount Allowed O `
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F � a�/ ,Qa �ooa_6-1�-oa �ao� /3j$�i�. 1�
,z COUNTY BOARD OF REVIEW � D'� *See False Statement Penalty Below / �� r—O /
,,,, ACTION `�
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[.Wy APPROVED IN AMOUNT OF S . �
� IOMSER'S FUIL RAMEI
2 REMARKS � � � -
r � ^� /� /] � IPEPSO\ AUT�j�RIZE BY D�EU POWER�A R.\EYI
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1! �! ��s 3 � X � y
1.� V `�-/� (FULL RFSIDERCE ADDRFSS OP O' A— MUST 9E GIVEY)
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A 'aECRETAftI' OF BOARD �'0 �� _ (AUURFSS OF AVfHORIZED R50\I �
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