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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R71 / 6-09)
Prescribed by Department of Local Government Finance
Coun Townshi Year
5 �� 12
: .FileJvlark:� �__.
INSTRUCTIONS:
To be filled in person or by mail.
Filing Dafes: 1) Real Property Musf be completed and dated in the calendar yearlo� which the deduction is sought.
Must be tled with the County Audiforor County Recorder o! the munty where lhe property is located
on or be%2 January 5 of fhe immediately succeeding calendar year.
2) Mobile /Manu/actured Homes not assessed as Real Property: Must file with the County Auditor o! the
�unty where fhe property is located dunng the hvelve (f2) monlhs be(ore March 31 of each year the
deduction is sought.
See reverse side for additional instruclions and aualifications.
or mnnact ouyer- see resmcnons on reverse
E. Riggins and Tawnya D. Riggins
Key number / legal descrip6on 26-18-36-200-001
Drive Haubstadt, Indiana 47639
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26-18-36-200.0�b-024
7, curtent year
hal is his / her exact :
�� on record is differerc
>f mortgagee or conV
Fargo Bank, N.A.
as of Mortgage / Contrad Intlebtetlness unpaltl as
March 1, wventyear
S199.990.00
101 North Phillips Avenue, Sioux F
Name of assignee or other owner or holtli
Address of assignee (number and street,
Does applicant own properry in any other
counry in Indiana?
❑ Yes
/ 702 W Conwell
date of application
If owned with someone other than spouse,
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Is Ne applicant the sole
legal or e itable owneR
es ❑ No
Is th�e '° perty in question: Mnualry Assessea
&]'RealProperty ❑ Annualty Assessed
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yes,
Card NO.�.�.�„��,�,%....