HomeMy WebLinkAboutMortgage_Kaysea.m � ae.,� ��� �/� — � � � � r-��s eK s�.00
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CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS '✓—.
TO BE FILED IN PERSON OR BY MAIL IN DUPLICATE EACH YEAR BY THE OR'NER WITH THE COUN'fY AUDITOR �
'� pN WHICH THE PROPERTY IS LOCATED) BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
(61.1-12-I THROUGH 6-1.1-12-8)
'•'QUAL[FICATIO�S ON BACK'•' oOO
�.y �
STATE OF INDIANA /�!�(t� pk� COUNTY, ss:
i . �, i'� ' . ., i /
[, �we) �
�FUIL NMfE7
certify tha[ [, (Ne) was/were legal resident(s) of the State of Indiana and owner(s) of real property an D1azch 1, 19 and that this
statement is made fo�he pu:pose of obtaining a deduction from that real property located in Taxing District (City, Town, Township)
Legal Description/or Key \umber "'" ' C
!03//D�//OS//OQJ
Described W wik
� Name on property tax records if different from above?
z � g � $ 3(,
A .
z Are you t� ter"��al ti•�,m ble owner of the real estate? S'es � No
� If nq w6at'is y�urr-ez��sFar�nterest in it?
� Assessed va1�A'�Nf� r��e���s of March 1, current year /O �O � ���0 � ��J �
(� � /CDOO
A . Amount'of4tito or� act debtedness unpaid as of March 1, �current year $ �
AUDITOR �
� Diortgage or Contract rernr V County Recorder's�OIffice, Record No. � page 36 0
�" Nazne and address of mortgagee or contract seller �U �-�-C.�- '–• ��/`_
WDo you know if there is any assignee or bona fide owner or holder of the mortgage or contract? 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 Count}� in the State of Indiana?
`" �6os-/�
(�J Yes No If yes, what County and Taxing District?
�
d Has this deduction been requested on that property for the current year? Yes No �
�
(f� Amount Allowed " - � '
� a
E �oo �v s�ly'9 � fln o � '��j %2,
,z COUNTY OARD OF REVIEW ����►*See False Statement Penalty Below U
`., ACTION .
(.Wy APPROVED IN AMOUNT OF $ b� Q� OV� —�c_ '
� - / /� 10 • . •S FUIL \ANE/
� � /
r REMARKS . �
� �PERSOS AUTHO�D BY �� f/i'Ep POWER OF ATIVRNEYI
� l3a3 �
�,. 0 �� �,.�,.�
�NLL RESIDESCE ADDRGSS OF ON'\ER — NUST BE GR'ES)
z a p R ��:�'o.,.. �
A �� 1 .%'.Ld �h.a.r-�c� /
cecn�nn�' oe MnRO UDDRESS OF AIII'HORIZE ERSOSI
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