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ego STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a . . FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609)
.*iiiiwici Prescribed by Department of Local Government Finance '
INSTRUCTIONS: - I .�j� .)
To be Wed in person or by mail. orm ed vnI
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �� Qg yr{y Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located C C T g5 [p I J
on or before January 5 of the immediately succeeding calendar year. LJ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Applicant(owner or contract buyer-see restri rCjerse side)
ROBERT B EGBERT AND TRACY E ERT
Taxing District Key number/legal description I n r P�Wm(/4 OAKLAND CITY 26-14-18-102-000.802-007
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
110200 101134 101134 I GI Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
IS ReallProperty ❑Annually Assessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller
FLAGSTAR BANK FSB
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
PO BOX 7026 TROY MI 78007
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this'd eduction been requested on property
county in Indiana? Lr—�,/ for current yea
r?❑ Yes No I ❑ Yes ❑ No
I
COUNTY AUDITOR
Deduction approved in the amount of:
I
20 20 20 20_ 20 120 20
signet a of County Audiior County I Date(month.day.year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(ow s 7u0 n � — I Date(month,day,year)
o—lGtI T
Full resident address of applicant(number and street,city,state,and ZIP code)
1011 WEST DRIVE,OAKLAND CITY,IN 47660
Person authorized by duty executed Power of Attorney or by IC 6-L1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city.state,and ZIP code) I