HomeMy WebLinkAboutMortgage_Dougan (2)--�T _ - �
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Form�Rev� - - . . . ��1 , F9in6 Fce ilAO
Presm4d by'u. �,re Board af Te: Cammissbnen � �,
Y1 i
CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS ' �
TO BE FILED IN PERSON OR BY MAIL IN DUPLtCATE EACH YEAR BY THE OWNER WITH THE COUNTY AUDITOR
(IN WHICH THE PROPERTY IS LOCATED) BETR'EEN MARCH 1 AND MAY 1Q INCLUSIVE
(61.1-12-1 THROUGH 6-1.1-12-8)
'°QUALIF�ICATIONS ON BACK°• -
� STATE OF INDIANA
I, (Ne)
certify [hat I, (Ne) was/were ! al residenqs)
statement is made for the purpose of obtaj ing a
Lega] Description/or Key Number
�
COUNTY, ss
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js�
State of Indiana and owneKs) of real property on �March 1, 19 and that this
duction from that real property located in Taxing District (City, Town, Township)
� Name on property tax records if di(ferent from above?
z
�
A �
z Are you the sole legal or equitable owner of the real estate? Yes
H
�
� If no, what is your exact share of interest in it? �
OAssessed value of real estate as of D7arch l, current year �
e�
No � 89— �y9
�
Described to wit
� Amount of D7ortgage or Contzact In tedness unpaid as of Mamh 1, current year S rx ���� �� �j/
, Dlortgage or Contract recorded County Recorder's Office, Record N � Page ��
""S Name and address ot mortgagee or contract seller
� Do you know if there is any assignee or bona fide owner or holder f he mortgage or mntract? Yes No � If yes,
Qwhat is the name and residence? � l
� � � ���
�
zDoes the owner of the above described real property own real property in any other County in the Stace of [ndiana?
� �60 </-�
t} Yes � No If yes, what County and Taxing District?
x . �z oes-/n
Q Has this deduction been requested on that property for the current yeai? Yes No
�
Cf� Amount Allowed
F �/ea � ��/�'i R� ,e
z COUNTY BOARD OF REVIEW
i„� ACTION
(.W.q APPROVED IA' AMOUNT OF S
3 REMARKS �
E �
�
A
SECREI'ARY OF BOARU
DATE
boA 8�°�r ,Q
a �5-o i �i�
(y � •See False Statement Penalty Below
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D� I IOWNER'S PULL YAM •
� t IPF.RSOS AUTHORIZED BY WL OF ATIO&\EY)
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� o q 13 1969
On UDDRFSS OF�I7i'HORIZED pEA50�'1 � /
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