Fill and Sign the Dation Form

PARTIAL DATION EN PAIEMENT UNITED STATES OF AMERICA BY [_DEBTOR_1_] AND STATE OF LOUISIANA [_DEBTOR_2_] TO [_CREDITOR_] PARISH OF [_PARISH_] BE IT KNOWN THAT BEFORE the undersigned Notary or Notaries Public, duly commissioned and qualified in and for the respective Parishes of execution, and in the presence of the witnesses hereinafter named and undersigned PERSONALLY CAME AND APPEARED: [_DEBTOR_1_] , whose Tax Identification Number is [_TIN_1_] , and [_DEBTOR_2_] , whose Tax Identification Number is [_TIN_2_] , husband and wife, domiciled in [_Domicile_Parish_] , and having as their present mailing address [_Address_] ; referred to jointly herein as " APPEARER "; who declared and acknowledged to me, Notary, that APPEARER borrowed certain sums from [_CREDITOR_] , whose Tax Identification Number is [_TIN_3_] , hereinafter referred to as " CREDITOR ", on a certain mortgage loan obligation, namely: A certain promissory note executed [_Note_Date_] by APPEARER to the order of CREDITOR in the principal amount of [_$Amount_] , bearing interest at the rate of [_Rate%_] per annum and providing for [_Fee%_] attorney's fees in the event of being placed in the hands of an attorney for collection, payable [_Terms_] , which promissory note is paraphed for identification with that [_Type_] Mortgage dated the same date, recorded at Mortgage [_Recordation_] of the mortgage records of [_Recordation_Parish_] , Louisiana and bearing against the property described below. The parties hereto declare that as of this date there is due on the mortgage obligation the amount of [_$Principal_] , with interest at the rate of [_Rate%_] per day from [_Interest_Date_] until paid, plus [_Fee%_] of said principal and interest as attorney's fees. Wishing to be released from the said indebtedness and to reimburse the said CREDITOR for a part of the indebtedness due and owing as hereinabove stated, and being unable to pay the amount represented by said note, and in accordance with the provisions of Articles 2655 to 2659, inclusive, of the Revised Civil Code of the State of Louisiana, APPEARER does hereby make unto the said CREDITOR a Partial Dation En Paiement, whereby APPEARER does hereby transfer, convey, deliver, grant, assign and set over unto the said CREDITOR , here present and accepting, all and singular, in partial satisfaction of the indebtedness recited above, the following described property: [_Property_Description_] The property conveyed herein has as its address [_Prop_Address_] . TOGETHER WITH all ancillary rights pertaining to or arising out of the ownership of the said property, including specifically, but not exclusively, all utility or other deposits, all escrow deposits, all prepaid insurance, or return premiums and all other rights or credits of a similar nature, existing or arising hereafter. TO HAVE AND TO HOLD said property as herein described unto the said CREDITOR and assigns forever, with full and general warranty of title, free from any lien, mortgage or encumbrance whatsoever, except that Mortgage referred to above, and with full subrogation to all the rights and actions of warranty which APPEARER has or may have against all preceding owners or vendors. APPEARER specifically warrants that: (1) APPEARER knows of no adverse claim to the property or litigation affecting title to the property; (2) No petition in bankruptcy has been filed by or against either APPEARER ; (3) APPEARER knows of no notice from any public authority requiring any improvement or change in the property; and (4) All parties who have furnished labor or services for maintenance, repair or improvement of the property have been paid in full; (5) APPEARER has not received notice from any environmental regulatory agency that the property described above is or may be subject to any notice or violation, penalty, assessment, administrative or judicial enforcement process directed toward remediation of environmental violations, contaminations, pollution or hazards, and APPEARER has no actual knowledge of any condition on or in the property that would subject CREDITOR , or any assigns of CREDITOR , to such enforcement; and (6) APPEARER has not received notice and has no knowledge of any private claim or threatened private claim by any individual or entity for liability of any kind whatsoever, including without limitation, personal injury, present or future medical costs, property damage, diminution in value or loss of resources, in any way related to the condition of the property. @@@Commercial@@@ APPEARER and CREDITOR acknowledge that the mortgage indebtedness and mortgage referred to above were and are commercial transactions as defined in LSA-R.S. 13:4108.1 and that the property transferred herein is agreed to have a reasonably equivalent value of [_$Value_] . This transfer and conveyance of said property by the said APPEARER is made and accepted in partial satisfaction of the indebtedness recited above, and only to the extent of [_$Value_] , APPEARER and CREDITOR agreeing that APPEARER and each of them shall remain solitarily liable to CREDITOR in the amount of [_$Remaining_] , being the difference between the total indebtedness recited above and [_$Value_] . @@@Consumer@@@ APPEARER and CREDITOR agree that the debt referred to above is a consumer transaction as defined by LSA-R.S. 13:4108.2 and that the present value (the reasonably equivalent value) of the property described above is [_$Value_] . This transfer and conveyance of said property by the said APPEARER is made and accepted in partial satisfaction of the indebtedness recited above, and only to the extent of [_$Value_] , APPEARER and CREDITOR agreeing that APPEARER and each of them shall remain solidarily liable to CREDITOR in the amount of [_$Remaining_] , being the difference between the total indebtedness recited above and [_$Value_] . APPEARER (a) acknowledges that APPEARER and each of them has a right to have the property transferred herein appraised and have the value of the property (and the credit allowed against the debt) fixed at three-fourths of the appraised value; (b) gives up the right to judicial appraisal and sale of the property and to any further judicial proceedings concerning judicial sale of the property; (c) agrees that CREDITOR may obtain judgment for the [_$Remaining_] remaining debt due, if that debt is not paid; and (d) agrees to sign all necessary documents in order to confirm title in CREDITOR . The said CREDITOR thereupon delivered to the Notary before whom it appeared, the [_Note_Date_] promissory note referred to above, which said Notary then paraphed for identification with this transaction and returned to CREDITOR , and CREDITOR , as the last holder of the said note, does hereby authorize and direct the [_Clerk_of_Court_and_] Recorder of Mortgages of the Parish of [_Recordation_Parish_] , State of Louisiana, to place a notation on the mortgage recorded at [_Recordation_] , showing that the property referred to above has been released from the effects of the mortgage. @@@Tax_Receipts@@@ Tax receipts and/or certificates are annexed hereto showing payment of all state, parish, municipal and levee district taxes and past due charges for local improvement assessments assessed against the property. @@@Conveyance_Cert.@@@ By reference to the certificate of the Register of Conveyances for the Parish of Orleans it does not appear that said property has been alienated by the vendor. The parties are aware that the certificate attached hereto is open, being not yet dated and signed, and relieve and release the undersigned notaries from all responsibility and liability in connection therewith. THUS SIGNED ON [_Date_1_] at [_City_Parish_1_] , Louisiana, in the presence of the undersigned Notary Public, qualified in said State and Parish, and the undersigned competent witnesses, who have signed with the parties after due reading of the whole. WITNESSES: ____________________ _________________________ [_DEBTOR_1_] ____________________ _________________________ [_DEBTOR_2_] __________________________ [_NOTARY_1_] , NOTARY PUBLIC THUS SIGNED ON [_Date_2_] at [_City_Parish_2_] , Louisiana, in the presence of the undersigned Notary Public, qualified in said State and Parish, and the undersigned competent witnesses, who have signed with the parties after due reading of the whole. WITNESSES: [_CREDITOR_] ________________________ BY: ___________________ [_AGENT_] [_Office_] ________________________ ________________________ [_NOTARY_2_] , NOTARY PUBLIC * * * * * * * * * * PARTIAL DATION EN PAIEMENT - F1ADAT2 : This is a transfer of property in partial satisfaction of an obligation, with options and language for commercial and consumer transactions. Where the debt arises out of a commercial transaction, the borrower and creditor agree on a credit to be allowed for the property and agree on the debt remaining, in accordance with R.S. 13:4108.1. Where the debt arises out of a consumer transaction, R.S. 13:4108.2 requires that the parties agree on the value of the property and requires that the debtor be given notice of judicial appraisal and sale rights. WORD KEY EXPLANATION [_DEBTOR_1_] Name of first party granting dation. Names of parties granting dation should agree with names in acquisition of property. For alternate appearances, see document Appearances - F1AAPP1. [_DEBTOR_2_] Name of second party granting dation. [_CREDITOR_] Name of creditor to whom property is transferred. [_PARISH_] Parish(es) in which agreement is executed. [_TIN_1_] Tax Identification Number of first debtor. For discussion of Internal Revenue Service reporting requirements, see document Request for Tax Identification Number - F1ASAL14. [_TIN_2_] Tax Identification Number of second debtor. [_Domicile_Parish_] Parish of debtors' domicile. [_Address_] Mailing address of debtors. [_TIN_3_] Tax Identification Number of creditor. [_Note_Date_] Date of mortgage note. [_$Amount_] Principal amount of mortgage note (with $). [_Rate%_] Interest rate on mortgage note, (with %). [_Fee%_] Percentage attorney's fee on mortgage note (with %). [_Terms_] Recite payment terms of note. [_Type_] Describe type of mortgage (conventional, collateral, etc.) [_Recordation_] Recordation data on mortgage. [_Recordation_Parish_] Parish in which mortgage is recorded. [_$Principal_] Principal amount due on date dation is signed (with $). [_$Rate_] Interest per day (with $). [_Interest_Date_] Date from which interest accrues. [_Property_Description_] Description of property, with acquisition. [_Prop_Address_] Municipal number or address of the property conveyed. @@@Commercial@@@ This paragraph is inserted where the debt is a commercial obligation within the definition in R.S. 13:4108.1 and the property is transferred in partial payment. [_$Value_] Value of property (with $), where applicable. [_$Remaining_] Difference between debt and value (with $), where applicable. @@@Consumer@@@ This paragraph is inserted where the debt is a consumer obligation within the definition in R.S. 13:4108.2 and the property is transferred in partial payment. Make appropriate entries for [_$Value_] and [_$Remaining_] . [_Clerk_of_Court_and_] Delete for Orleans Parish filing. @@@Tax_Receipts@@@ Include statement and receipts/certificates showing payment of taxes in conveyances of real property located in municipal corporations exceeding 300,000 inhabitants, as per R.S. 9:2921. @@@Conveyance_Cert.@@@ Where real property located in the Parish of Orleans is conveyed, R.S. 9:2928 requires attachment of a certificate of the Register of Conveyances showing that the seller has not alienated the property. [_Date_1_] Date of execution by debtors. [_City_Parish_1_] City and parish where dation executed by debtors. [_NOTARY_1_] Notary before whom debtors sign. [_Date_2_] Date of execution by creditor. [_City_Parish_2_] City and parish where dation executed by creditor. [_AGENT_] Name of person appearing for creditor. [_Office_] Office held by person appearing for creditor. [_NOTARY_2_] Notary before whom creditor signs.