HomeMy WebLinkAboutHomestead_Kapp,j NA SALES DISCLOSURE FORM SUE ID: Pa e 2
D.PREPARER
Val J. Rein Attorney at Law
Preparer of tF. =. Sales Disclosure Form Title
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l95 %orth Ninth Street Val J. Fleig Law Office
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Ad— d?ess(Ahmber and Street) Company
Petersburg, IN 47567 (
E -mail
E. SELLERS GRANTORS
Estate of Jerry P Keith
Estate of Jerry P. Keith
Seller 1 - Name as appears on conveyance document
r)o Melinda Keith, 801 N Whlleriyer Avenue
Seller 2 - Name as appears on conveyance document
Go Melinda Keith 901 N Whiteriver Avenue
Address (Number and Street)
Petersburg IN 47567
Address (Number and Street)
Petersburg IN 47567
Ciy, State, and ZIP Code
City, State, and ZIP Code
-
E -mail
Under penalties of perjury, 1 hereby certify that this Sales Disclosur , to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance w' IC 6- 1.1 -5.5, "Rea Property Sales Disclosure Act ".
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-r fSeller
Signature of Seller _ Sign A
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Melinda Keith Cn- Personal Representative S Geoffry P Keith Co- Personal Representative
Print Sian Date MM /DD Printed Name o Seller Si nDate(MM/OD
. BUYERS GRANTEE (S - PLICATION FOR PROPERTY TAX DEDUCTIONS- IDENTIFY ALL ITEMS THAT APPLY
Anthony Ray Kapp
Buyerl Name as appears on tonveyanc current
Buyer 2- Name as appears on conveyance document
olf
Address ry .. dstree[)
Address (Number and Street)
tinslow. IN 47598
Y. State. and ZIP Code
City, State, and ZIP Code
E -mail
Telephone E -moil
THESALES DISCLOSURE FORM MAYBE USEDTOAPPLYFOR CERTAIN DEDUCTIONS F PROPERTY. IDENTIFYALLO OSET PPLY.
ITS NO CONDITION NO CONDITION
F] [x] 1. Will this property be the buyer's primary
® ❑ 3. Homestead
residence? Provide complete address of prima
. Solar Ener g /Cooling System
residence, including county: I
❑ ❑ 5. Wind Power Device
6. Hydroelectric Power Device
Add. (Number and Street)
❑ x❑ 7. othermal Energy Heating /Cooling Device
❑ X B. Is this property a residential rental property?
city, St. to ZIP Code county
❑ x❑ 2. Does the buyer have a homestead in Indiana to be
vacated for this residence? If yes, provide
❑ 9. Would you like to receive tax statements for this
complete address of residence being vacated,
property via e -mail? (Provide contact information
including county:
below. Please see instructions for more information.
Not available in all counties.)
V ( b(17 —00
Address (Number and Street)
Cary, Soto ZIP Code County
Primary property owner contact name Email
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct
and complete as required by law, and is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ". (Note:
Spouse information, Social Security and Driver's License /Other numbers are not necessary if no Homestead Deduction is
beir.0 rilled.�)
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I '. Signature afBuyer2 /Spouse
Signature o)HI)ar1� ,
0-ihony Ray Kapp
rcte�d Legal Name of Bayer l Sign bate(MM/DD/rvn') Printed Legal Name of Buyer 2 /Spouse Sign Don, (MM/DD/n Y)
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Security Number Last 5 digits of Buyer2 /Spouse Driver's State Last 5 Digits of5ocial Security
License /ID /Other Number Number License /ID10ther Number
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