HomeMy WebLinkAboutMortgage_Moore (6)Fmm 5 Rerised t4]! /� P�line Fa SI.00
Prncribed bY �e Su�e Boa�d o( Tea Commiuionere (� � Q��
� �
ti�
�
Ql �l
CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS L'—'— �"
TO BE FILED IN PERSON OR SY MAIL IN DUPLICATE EACH YEAR BY THE OWNER WITH THE COUNTY AUDITOR
-(IN WHICH THE PROPERTY IS LOCATED) BETWEEN MARCH 1 AND MAY 10, INCLUSIVE /� ,
(61.1-12-1 THROUGH 8-I.1-12-8) . � / J
°•QUALIFICATIONS ON BACK°• b
�(Ne) —
certify that I,
statement is i
STATE OF INDIANA �� ` COUNTY, ss:
.
y�as/were legal resident(s) of the State of
for the purpose of obtaining a deduction
Legal Description/or Key Number
. '
:i��
I
♦
✓-
�ME) ' p
and owner(s) of real property on March 1, 19 O and that this
.t real pSoperty located in Taxing District (City, Town, Township)
� Name on property tax records if different from above? � '
z �
.,
A
z, Are you the sole legal or equitable owner of the real estate? Yes No
►-i ���(j
� If no, what is your exact share o[ interest in i[? �CT-' ���
/ � � Z
� Assessed value of real estate as of March 1, current year V D � pS
A Amount of Mortgage or Contract Indebtedness unpaid as of March l, current year 3 �� O - I-D
w
a� D1ortgage oc Contract recorded
W _
� d dd ( rt r contract seller
County Rernrder's Office, Record No. � Page ��'�_
_/ . .. /J �% D
W Aame an a ress o mo gagee o .
� : i
� Do you know it [here is any assignee or bona fide owner or holder of the mortgage or mntrac[? 1'es No If yes,
W � /ll �t,I%�
O�� V
Q �hat is [he name and residence?
a � ✓J �i .
I Does the owner of the above described real property own real property in any other County in the State of Indiana?
z
�
C� Yes � No If yes, what County and Taxing District?
Q Has this deduction been requested on that property for the current year? Yes No , v�
� n, .
(/j Amount Allowed
` E 4'1- o0 6/aa�+ /j cP
z COUNTY BOARD OF REVIEW
,,,, ACTION
W APPROVED IN AMOUNT OF $ � 60
E
�.
�� REMARKS
, - � � , � �� �b
z _ „
O . A ; JV-
A
CR R'
� _ _� . � • AuoiTOR
� 66� ��1� �
a 7•See False Statement Penalty Below
�
� D.
�
ti_ 03
1�p�
�� � `
A (AODRFSS OF AfTiHORIZEO PER50\I
� � '�- s_9� .d- d-�-� .
,r
, ��
\
�-;,