HomeMy WebLinkAboutMortgage_Wells (4)Form.i Rerised IAiI . O�/� _!� 1 I�� �e Fee Sl-00
Prescribed 6r �e Sum Floerd of Tax Commiss�onere (� / � �
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CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
TO BE FILED IN PF,RSON� OR BY MAIL IN DUPLICATE EACH YEAR BY THE OR'NER WITH THE COUNTY AUD[TOR
QN WHICH THE PROPERTY IS LOCATED) BE7'R'EEN MARCH 1 AND MAY 10, INCLUSNE
161.1-12-1 TNROUGH 64.1-12-8) �
( "'QUALIFIC� QQ\S ON BACK'^ I/1'/\�\�
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TE OF
I, (We) �eN W / � v��vCY L� '
certify that I, (We) was/were legal resident(s) of��
statement is made for the purpose of obtainin � de
Legal Description/or Key Number
Name on property taac records i( difterent from above?
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of Indiana and owner(s) of real property on Dfamh 1, 19 ��and that this
rn from that real p�erty�located in Taxing District (City, Town, Township)
Are you the sole�legal or equitable owner o( the real estate? Yes No
If no, wha[ is your exact share of interest in it?
Assessed value of real estate as of March 1, current year
Described to wit:
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Amount of Mortgage or Contract Indebtedness unpaid as of March 1, cunent year $ d�� •� ���
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Mortga�e or Contract recorded
Name and address of mortgagee or contract seller
Caunty Recorder's Offce, Record No. Page
Do you know it there is any assignee or bana fide owner or holdez of the mortgage or contract? Yes No [f yes,
what is the name and residence?
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Does the owner of the above described real property own real property in any other County in the State of InBiana?
Yes _� No If yes, what County and Taxing District?
Has this deduction been requested on that property for the curtent year? Yes No �����
. . . . r� /J . ., ��
Amount Allowed
��t��/aa �/�/G
COUNTY BOARD C
ACTION
APPROVED IN AMOUNT OF S
REMARKS
DATE
SECREfAftY OF BOAltD
- � ` � (�iAY 9 i99U
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'See False Statement Penalty Belown� -� -- s
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/ / IOWNER'S FULL \AME)
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P �PEH50\ AUINORIZED BY ULS E%ECUTED POWER OF ATTORNEY)
� a�o� � as s. �,�sd,�/
n ^ If'I+LL RFSIDESCE ADDR6i5 OF ON'\ER — MUST 8E GIVECI
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