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HomeMy WebLinkAboutHomestead_Doerner (7) INDIANA SALES DISCLOSURE FORM SDF ID SDO ID 1768452 Paget D.iPREPARER.- -' -.. - - ;`` . . ` f.:: .... _ : . '°. , J . "-- Kimberly A.Lewis Office Manager �Preparer of the Sales Disclosure Form Title 26 W.Broadway Broadway Title,Inc. Address(Number and Street) Company Princeton, IN 47670- 812-386-1687 kim-bti @insightbb.com City.Store.and ZIP Code Telephone Number E-mail iE.,SELAlER(S)%GRANTOR($) -- " r.t k-t-k=_..::..` 'L'.:LT. _"._ -?rsi: - _j -. Stephen B.Beasley Seller 1-Nome as appean on canvpance document Seller 2-Nune as appears on Cansryafce document 9649 E Base Rd. Address(Number and Street s Address(Number and Street) Oakland City,IN 47660- Telephone Number E-mail 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". Signatu of Seller U c Signature of Seller -- ' • .✓ L . A a is -.24- /3 PrintA en!conn Bien Dan R•Nmn/1mm Pr'nbd Nmne nfedler ei',t)-Pe tu,•/P"•ws"n ////````F-'BUYER(S)/GRANTEE(S). APPLICATION•FOR PROPERTY„TAX'DEDUCTIONS=IIDENTIF,Y;ALL ITEMS'THATAPPLY,_`-±17--:-.-C-7:** C.C.Ann Deemer —8tlyer-rteurlrc appears on conveyance document Buyer 2 Name as appears on conveyance document 464151100E Address(Number and Street) Address(Number and Street) Somerville,IN 47683- � Telephone Number E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY. YES NO CONDITION I YES NO CONDLI nN © ❑ 1.Will this property be the buyer's primary Cili ❑ 3.Homestead 3 residence? Provide complete address of primary ❑ © 4.Solar Energy Heating/Cooling System residence,including county: 4641 S 1100 E ❑ © 5.Wind Power Device Address(Number and Street ❑ ❑ 6.hydroelectric Power Device I Somerville,IN 47683 GIBBON ❑ © 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be ❑ © 8.1s this property a residential rental property? 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. Address(Number and Street) J6 -2D-0/ -too - 000, 5.9y-oo/ City,State ZIP Code •unty -...•• ro er owner contact name E- d 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 being filed.) Signature of Beyer! Signature of Buyer2/Spouse Rc.r. �«ef 4.94-13 ® Number License/ID/Other Number 1..•