HomeMy WebLinkAboutMortgage_Whitehead (2)r'
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Yrescribed by Ne Suu BoaN o(Ta. Commusioners �
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� CERTIFICATE OF MORTGAGE OR CONTRACT INDEBTEDNESS
TO BE FILED IN PERSON OR BY MAIL t\ DUPLICATE EACH YEAR BY THE OWNER WTTH THE COUNTY AUDITOR
(IN R'HICH THE PROPERTS' IS LOCATED) BE7'R'EEN MARCH 1 AND MAY 10, INCLUSIVE
(6-1.1-12-1 THROLiGH 6-1.1-12-8) '
"'QUALIFICATIONS ON BACK••• /I � OD
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STATE OF INDIANA /si<(-Lw�- COUNTY, ss:
I, (We) � XL�G�.tc..0 . �. `J,(�1.n, u//'I�vw�t�+�,,,_
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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 D7arch 1, 19 v� and that this
statement is made for the purpo� of obtaining a deduction from that real property located in Taxing District (City, Town, Township)
Legal Description/or Key A`umber
Described to wit:
� Name on property taac records if difterent from above?
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z Are you the sole legal or equitable owner of the real estate? Yes No ��-' �� �
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� If no, what is your exact share af interest in it? _
OAssessed value of real estate as of March 1, current year ✓��� 3�'�Q ° �/ v
W. Amount of Mortgage or Contzact Indebtedness unpaid as of March 1, current year S /L 0 0 0 —
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p7ortgage or Contract recorded � • County Recordei s Office, Record No. � Page �S �
� Name a� s'g C� r contract seller �r Li17�/ �� �"t^-�-�-�-�
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W -Do you know � fAer �s'an 9 tgnee or bona fide owner or holder of the modgage or crontract? Yes No If yes,
Qwhat`is �the �naPm� an� re si He T �ce? Q � �� � _
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I AUDITOR
z Does the owner of [he a ove described real property own real pzopem� in any other County in the State of Indiana?-
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� � Yes No If yes, what County and Taxing District?
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Q Has this deduction been requested on that property for the cunent year? Yes No
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� Amount Allowed '
x -t�=va G/�/9�
E COUNTY BOARD OF
z ncTiorr
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[.Wy APPROVED IN AMOUNT OF S
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� REMARKS
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SECRETARI' OF BOAF[D �
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'See False Statement Penalty Below
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(OW�ERS FU11. NAME)
DATE I� 7�� �C.��� �,,..7�-fc. , � —�
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