HomeMy WebLinkAboutMortgage_Ellerbrook �+ CountyTownship Year
�y &,,., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
yi`�A i }s FOR DEDUCTION FROM ASSESSED VALUATION
3 �> State Form 43709(R11 6-09) Gibson Oakland City 2022
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail.
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. Form filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located El County Auditor
on or before January 5 of the immediately succeeding calendar year.
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of the County Recorder
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.
Applicant(owner or contract buyer-see restrictions on reverse side) ` .��5��
' Lexuss Kay Ellerbrook - -C-r—/-/-/Y�-" 30 -6� o=d nu er Page number
Taxing District R Key number/legal description P)-1 ga5
* 'WEST ENLG 2 6LK 2 WEST ENLG 3 BLK 2 0(
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
* $0.00 *$8-80 1 q f, (..„--76/60 *$99,674.00 ❑x 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 Assessedcc
El Real Property ❑ Annual�;, essed p
Mobil=CM (IC 6-1.1-7) . O
Name of mortgagee or contract seller . c
N
Address of mortgagee or contract seller(number and street, city,state,and ZIP code) '..:1' (ten z_
PO Box 3490,Little Rock,AR 72203 o v
Name of assignee or other owner or holder of mortgage Q �Q
co O
Address of assignee(number and street, city,state, and ZIP code) m
m_
Does applicant own property in any other In yes,what county? What Taxing District? Has this deduction bee re ues ed on prope 5
for current year?
county in Indiana? It Yes 0 No
0 Yes IMF No
COUNTY AUDITOR
Deduction approved in the amount of:
20
20 I 20 20 20 20 20
County Date(month,day,year)
Lgpature f County it LA�AA 1 bS M 5- y-Z2)2,7
I/We certify under the penalty of perjury t a 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 pro erty on date application is filed. Date(month,day,year)
>'SatureAowner's full name)
y 04/28/2022
Full residentaddress of ear ap icantt(number and street, city, state,and ZIP code)
* 514 W.College St,Oakland City, IN 47660 Date(month, day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person(number and street, city, state,and ZIP code)