Mortgage_Engelbrecht •"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
� .. 1., FOR DEDUCTION FROM ASSESSED VALUATION r T
�''s'••` Prescribed Form by Department artm/6-09) G�s�t T �I n 012
/ esaibed by Department of Local Government Finance 1111 t L y �
INSTRUCTIONS: a 1I File Mark
To be filed in person or by mail. MUI o •`• Ai',
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located C,u. ,n: •unty Auditor
on or before January 5 of the immediately succeeding calendar year. I •`C�ty 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 yeaQIBSON •• • • • 1 •I •R
deduction is sought.
See reverse side for additional instructions and qualifications. •
Applicant(owner or contract buyer-see restrictions on reverse side)
Jason A Engelbrecht and Carrie A Engelbrecht
Taxing District Key number/legal description Record number Page number
Princeton Township 26-12-06-302-001.913-028 Pt NW SE&Pt NESW 6-2-10 DO 11 313(1
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,cunent year date of application legal or equitable owner?
•5175,300 S253,409 1I Yes ❑ No
no,what is his/her exact share of'merest? 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
Willaim M Pugh and Melinda A Pugh Trustees of the Pugh Revocable Living Trust \55421-1` O Real Property ❑Annually (IC 6
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
Fifth Third Bank
Address of mortgagee or contract seller(number and street city,state.and ZIP code)
5001 Kingsley Drive,Cincinnati, OH 45227
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 1 If yes,what county? What Taxing Disaict? Has this deduction been requested on property
county in Indiana? �1 for current year?
Y ❑ Yes /L�'No y ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 1 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.
nature(owner' j Date(month,day,year)
8/9/2011
of resident eddreds i•-•. (number and street,city,state,and ZIP code)
1036 N.Main Street,Princeton, IN 47670
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)