HomeMy WebLinkAboutMortgage_Palmerd� �;o� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count 7 n ip Y r
�, 4
FOR DEDUCTION FROM ASSESSED VALUATION
S• � � Slate Fortn <3709 (R71 / 6-09)
����, PresaiDed by Depanment of Loral Government Finance �
STRUCTIONS: � �
To be (Ietl in person or by mail For�, ti:�i -
Filing Dates: 7J'Real Property: Musf 6e compfefed and dafed in fhe cafentlar yea� toi which the tleducfion is sought ❑
Mus16e (led wi[h the CowtyAuditor or County Recorder o! the counry where tbe property is located Cou � r
on or belore January 5 0/ Ihe immediately succeeding calendar yeac GI $0�0�7i� pRjgpc�R
2) Mo6ile /Manulacfured Homes nof assessed as Real Property: Musl file with the CountyAudifor o! the
counry whe�e (he pmperty is located dunng (he twelve (72) montbs before March 31 o/each year f6e
deducfion is sought.
See reverse side lor additional insvuciions and qualilications.
Applicanl (ownor w tontracf buyer - see resMciions m reverse side)
Theodore H. Palmer and Joni R. Palmer
Taung Districl Key number / legal des<nption Rewrd number Page numGer
Johnson 26-23-15-400-001.777-024 p�0' l
Assessed value dreal property as ot Mortgage / ConUatl iMebleane55 unpaiE as of Mortgage I ConVact iMeOtedne55 unpaitl as o� Is Ne applicant Ne sole
March 1, curzen� year March 1, wnent year Cate ot apd��UOn legal or epuiu�le oaneR
S172,900.00 5224,000.00 ❑� Yes ❑ No
It no, whal is �is l her esact stare of interesO It ovmed wiN swneone other Nan spouse, intlicate xiN wtrom
If name on recor0 is CiPerent Ihan ihat of apdicanL i`Wicate Oelow: 151he property in QueSUOn: Ann�allyAS5e5SeC
❑� Real Property ❑ MnuallyAssessed
Mabile Home (IC 61.7-7)
Name o1 mortgagee or contracl seller
Wells Fargo Bank, NA
ACtlress ol morigagee or conVact seller (number arM s.reef, ciry. state, and ZIP code)
707 Phillips Road, Sioux Falls, SD
Name of assignee or other ovmer or holder of mortgage
- a v �
Adaress al assignea (number antl street criy. s:a:e. and ZIP ca0e) '
xs applicant am property in any ocher II yas, what counry? What Ta.ing Disvicl? Has this tleductbn been reques:ed m property
.nunry in Indiana? far cunent yeaR
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction apprwetl in Ne amount ot
20 20 20 _ 20 20 _ 20 _ 20
Sgnawre ol Counry AuOitor County �ate (rrwnth, day, year)
I/ We certi(y under the penalty of perjury thal �he above and foregoing infortnation is true and correct and that the applicant is a resident of Indiana and
owner / wnVact buyer of the aforementlonetl property on date application is fletl.
Signaty:� wners7uHname;�� � Date (mon:A, tlay. year)
Ny /f�� 02/24/2012
Fu0 resbent aCtlress ol apd��nt (number arM stmet, ci , s1 .e, arr0 ZIP wCe)
72693 S 350 E, Haubsiadt, IN 47639 �
Person authorized Ey duly executed Power of Attomey ar by IG 61.142-0.7 �ate (monlh, tlay, year)
AECress of auNmizeC person (number aM svret. city, s(ata. arrd ZIP tode)