HomeMy WebLinkAboutMortgage_Ballard^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBiEDNESS cou o Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
. s�e ram aa�os �n i s-w)
� % aresrn�cea q occ�M m Lod coremment Firo„ce
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INSTRUCTIONS:
To be filed in person or 6y mad with the CowrtyAWito! or Counry Recorder of the county where the propeRy is bcated.
Fiirg Dates: 1) Real Property: Must file dumg the year for which the deducfion is sought i u ditor
2) Mobife /Manu(actured Homes rrot assessed as Real Pmperty. Must file dunng the hveNe (12) mordAlBBb C 0 � TY����er
before March 31 of each year the deduc0on is soughG �
See reverse side for addrtional instructbns and qualifications.
Ap 1(o»(n�er(�wcontraCb`uyer-se}�e��+e�r�prtc mreverseside(�) ��-{('� ^ /�
�(l� \l VC]. � wJ. e L\. t� ie�(� e� i. 1'T � N i Al A'1 rA \ Ti
District
As�ed rfire of mal ptap¢fty as d
M2rt� 7, CVrent year
Key numeer
If ro. what is his / her eraf2 share ol interesl?
If name m
m�tgagee «conaaa sener
\ � t rI —JI
Mortqage / ConO
Marrh 1 curten[
mntract seller (numbe� erd stree4 �; sfate, aM ZJP cade)
Name ol assignee or other owner w Mder of rnor(gage
Addm55 of a5sgnee (number e/Id 5tree(, City, 57a1e, and
Ooes ePPlipnt wm property in any oNer
counry �n IrW'a�a? ,�-,�
❑ Yes 1_�hlo
Drductlan approved h� the armunt ol:
2� _ � 2� _ � 20
Cwa:ry nwimr
as o(
ovmeE
COUNTYAUDROR
Record m�mber Page number
�o�a s�4
IMe6tedness wPaid as d Is ihe ePP<<?�� Ne sa
No
otlwl than spouse, I�icate wlth wtwm
20 _ � 20 _
�
ProPeM in Question: MnuaM Asseaed
eaI ProPertY ❑ Nmually Assessed
Mohile Fbme (IC 6
r
�
Has Ihiv tleduction Deen r,�quested on o�^.. . _�
mr w�ent yrar.
�?, (�3. �0� a�, �..,...
Dra���er 1�....
5.��3.......
Card i�Q. ..... �
I/ We certity under Ne penalry of perjury that Ne above and toregoing Infortnation is we and correcc aM Nat the applirant is a resident of Ind'�ana a�
awner I mntract buyer of ihe aforemenGoned property on date application is filed.
� wre efs fu0 name) ,/`a/ Date (mw+th, daY. Yge�
��l
0 deU� aOCress°of appfimnt (numberarM sbeet, dy, stafe, ered LP mtle) >�
�In C ,t'.si� r�.vG�o.v 7JiP �i4irc� Ta�� _ �J �! ? 6
Pe�son
prJSOn (numberand sbaef, cdy, stata, end LP cade)
�r. r�A