HomeMy WebLinkAboutHomestead_Sams [H. PREPARER
Preparer of the Saes Disclosure Form Title
Taylor M. Millsap Attorney
Company
Address (number and street, city, state, country, and ZIP Code)
302 E. Main Street, Francisco, Indiana, USA, 47649
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I. SELLER(S)IGRANTOR(S)
• Seller 1 -Name as It appears on conveyance document Seller 2 -Name as appears on conveyance document
Melinda A. Sams David M. Sams
Address (number and street) Address (number and atreet)
322 West Washington Street 231 State Route 2839
City, State, and ZIP Code City, Slate, and ZIP Code
Oakland City, Indiana 47660 Dixon, Kentucky 42409
Country Country
USA USA
required by law, and is prepared In accordance with IC 6-1.1-5.5.A parson who knowingly and intentionally falsifies the value of transferred
real property, or omits or falsifies any Information required to be provided, commits a vei 5 felony.
Signature of Seiler V\ Sigiii ure r
Printed Name of Selzer Date Signed (mmlddtyyyy) P anted Name of Seller Da = Sig (mmldd/yyyy) ?
Melinda A. Sams 02 / 09 / 2026 David M. Sams /0. , I
J. BUYER(S)IGRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIO 4. R • .PLY
Buyer 1 -Name as It appears on conveyance document Buyer 2- Name as co •• •:at
Melinda A. Sams
Address (number and street) Address (number and street)
322 West Washington Street MAR 06 2026
City, State, and ZIP Code City, State, and ZIP Code
Oakland City, Indiana 47660
Country Country �.
USA i.t6;„aj
( )
Pursuant to IC 6-1.1.12-44,the Saks Disclosure Form may be used to apply for certain deductions.identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1. W U this property be the buyer's primary O 0 3. Homestead
CD 0 residence? 0 0 4, Solar Energy Heating or Cootirg System
2. Does the buyer have a homestead to be vacated 0 O 5. Wind Power Device
for this residence? If yes, provide address: 0 a 6. Hydroelectric Power Device
Address (number and street) 0 [a 7, Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
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