HomeMy WebLinkAboutMortgage_Ballard (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co n 7o Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
a = �' Sfata Fwm 43709 (R71 / 6-09)
S,u. � Presaibetl Oy DePa�M of Local Govemmenl Frence
wsrnucnoNS: SEP �1'�3��11
To 6e filed in person or by mail with the CountyAUditor or Counry Reoorder o/ Ne county whe2 the property is locafed. C F� fl� �:
Filing Dates: 1 J Real Property: Must file durirnj the year /or which the deduction is mught.
2) MobRe /Manufactured Homes irot assessed as Real Property: Must fiie dunng the hvelve (72J months ry�d��
before Maich 37 of eacA year the deduction is sougAt Co Reoorder
GIBSON OU Y AUDI OR
See reverse side (or adtlitional insfructions and qualilcafions.
'� Mo�N'(awneror contract b - sce o[9virtiortt on reverse sidel
�,�.
It nartie on mcv�tl's
rUme ot rtwrtgagee «
r i regai aesrnpuon Reco�d numDer Page number
, - _07 -Yo� -voa.s Y�-o�8
MortgageN/ Cantraa irWe6tedness un7aid az d �M�9a9e / Con7aa'uWebiedness �mpaid as of Is ihe ePP�t Ne sole
March pp(�cation kyy a�y¢ ownM
7�d ❑Yes ❑No
If axnetl wiN wmeone other than spouse. iMinte with wham _'
- ,Q�����-/�, �OGE�
P4tlress W mortgageE v contraG se0es (mun6erard sbeeL �'M sta.e, aM LP code) G
Name ol assgnee or oNer ovmer w hdder of mortgage
Adtlresso(assgnee urtNereMaUeet,dry,state,andZlPootle)
SE �7- d -/O
� appti� oxn ryoperty in any oNer If yes, what munry? •1
❑ Yes ❑ No
zo � zo
�--i. r
1/ We certi(y under Ne penal
owner I mntraq buyer of the
=�zS 1-
Oy dWy esecuted Power of Attorney
zo_ zo_
c
the above a toregoing intortnal
p�rty on ate application is fil<
person (number aiM stree; ciry, state. and LP rotle)
1 I � �-1 I �
��Ul7��s?
I-%LBU (./-�'�' `'�- . �lI A�c�.►� �
�
rssed I �
��
W�Y