HomeMy WebLinkAboutMortgage_Inglerd�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count
�a __ : FOR DEDUCTION FROM ASSESSED VALUATION
�' �� SlateFOrtna3709(Rtt/6-09)
PresaiEed by Depanment of Loral Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail.
Filing Dates: 1) Real Property: Musf 6e complefed and dated in Ihe calendar year /or which fhe deducUon is soughf.
Musl be filed with the CountyAudifoi or Counry Recorder o/ the counry where fhe ploperty is located
on or 6efore January 5 0/ the immedialely succeeding calendar yea�.
2J Mobile / Manu7ac(ured Homes not assessed as Real Property: Musl fi/e with fhe CountyAUditor ol the
county w6e2 the property is located dunng the twe/ve (12) months be/ore March 37 oleach year the
detluction is sought.
See reverse side lor additional insfructions and quali(cafions C' �BSON
�OmoqW Auditor
Cllll
County Recorder
Applicant (owner w connaC buyer- see res✓ictbns an raverse side)
Theodore H. Palmer and Joni R. Palmer
Taring �istritt Key number / legal descnption Record numDer Page numEer
Johnson 26-23-15-400-001-777-024 Pt NE SE 75-4-70 1
AssesseC value W real pmpeM as of Mortgage / Conlraa indebtedness unpaid as of Mortgage / CanvaU inEebtetlness unpaid as of is Ne applicant t�e sde
�arth 1. curzent year Ma¢h 1, curtent year date of aOW��� iegal w eQUiude ownera
172.900.00 S224,000.00 ❑O Yes ❑ No
� If no, wha� is his / �er ewU share of Interest? If ownetl nith someone other Uun spouse, inEicate wiN whom
on reoortl is Cifierent t�an
ame o( maM1gagee or convad
Wells Fargo Bank, NA
AEtlress o/ rtqrtgagee or mntraci seller (number arM s✓eel, dry, state, aM ZlPCOde)
701 N Phillips Avenuve, Sioux Falis, SD 57104
Name of assignee or oNer owner or holder of rrortgage
AEtlress of assignee (numDer and sbeet cdy. state. antl ZIP cade)
Is Ihe property in quesUOn: Mnually Asseuetl
Q Real Property ❑ MnuallyASSessed
Does applicant am pmperty in any oNer If yes, what counry? What Tazing Distnct? Has Nis tleEUCUOn �een requeste0 on property
counry in Indiana? for cunen� yeaR
n Yes ❑ No ❑ Yes Q No