HomeMy WebLinkAboutHomestead_Miskell (4)H. PREPARER .
eparer of the Sales Disclosure Form
Title
ndL. Hicks
Attorney
mpany
ndra L. Hicks Law Office, LLC
[r.a
Email Address Telephone Number
dress (number and street, city, state, country, and ZIP Code)
sandrahickslaw2@gmaiLcom (812 ) 615-5044
3 S9th Avenue, Haubstadt, IN 47639
I. SELLER(S)/GRANTOR(S)
Seller 1 Name as it appears on conveyance document
Doris F. Bilderback
Seller 2 -Name as appears on conveyance document
Address (number and street)
206 SW Mill Street
Address (number and street)
City, State, and ZIP Code
Patoka, IN 47666
City, State, and ZIP Code
Country
Gibson County - USA
Country
Email Address Telephone Number
( 812 ) 664-2020
Email Address Telephone Number
Under penalties of perjury, i hereby certify 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. A person who knowingly
and intentionally falsifies the value of transferred
real property, or omits or falsifies any information required to be provided, commits a Level 5 felony.
ignature of SeIlef'
Signature of Seiler
rinted Name of Seller Date Signed (mmlddl
Doris F. Bllderback ((�- YYYY)
Printed Name of Seller Date Signed (mm/dd/yyyy)
J. BUYER(S)/GRANTEE(S) —APPLICATION FOR PROPERTY
TAX DEDUCTIONS
ABuyer 1 - Name as it appears on conveyance document
manda J. Miskelll
-1DEN F THAT APPLY
Buyer 2 - Name as it a ppears o cony a do
m
A dress (nu be--rs ee
and t)
�L'CJ
Address (number and street)
tat nd ZI C de
G t a r(4 H-1(o4PCo
J
City, State, and ZIP Code
?026
Country
Gibson County - USA
Country
G/e
SON
Email Address
Telephone Number
17i2 )���-/_rtn�
S (U [
Email Address
T'y D on Number
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Pursuant to IC
/TO
6-1.1-12�4, the Sales Disclosure Form may be used to appiy.for certain. deductions. Identify all of those that
YES NO CONDITION
apply;
YES /' NO CONDITION
® 1. Will this property be the buyer's primary
3. Homestead
residence?
❑ 4. Solar Energy Heating or Cooling System
❑ ❑ 2. Does the buyer have a homestead to be vacatedi,
5. Wind Power Device
for this residence? If yes, provide address:
❑ El 6. Hydroelectric
Power Device
Address (number and street)
❑ 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
Under penalties of perjury,) hereby certify that this Sales
�lsz- oti-ate- t o �- moo . a��oa
Disclosure,
as required by law, and is prepared in accordance with IC 6-1.1-5.5. A
transferred real property,, or omits falsifies
to the best of my knowledge and belief, is.true, correct, and complete
person who knowingly and Intentionally falsifies the value
or of
river's Liceany information required to be rovided, commits a Level 5 felon (Note: Both spouse's
information, SS Number is necessary only if a Homestead Deduction
S nature of Buy r I
n� IV .n to
Is being filed.)y.
Signature of Buyer 21Spouse
Printed Legal Name o B yer 1 Sign Date M/DD/YY)
Amanda J. Miskell
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Last 5 Digits of Buyer 1 SSN/Dri et's License/ID/other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
Page 3
INDIANA SALES DISCLOSURE FORM /SDF ID: Page 2
OP, . ..7F�� �i-.s"�'' . ;� :u' ri`1 a _` i' ti-TrAl',°' C°Ten.1,-tiy`L -7'
Pk.cn(kre)lk PC, 1--Ce_a-z;
Preparer of the Sales Disclosure Form Title
a 0 4 5 L (�r\ ,�l �t.
ress Number and Street) Company
A D Ilk \bk L-1-1 to 10
City,State,and ZIPCode Telephone Number E-mail
rr t 1 ( )/ __ – 3-,-- ,:,-7 h-t"-:° r"G f.:�:_T"t"- -`?:,,z� r7--.77%. "-Vtr-' n" at T
eE: ELLERS GRANTORS) -ate < - .r.-_.�=�i��;x,9Z�a*,;�_ti._ .z . i,a-r_c . ��;,..r tiz>� _ _.;-�_s,=
tors S E -V)-: Idle-l-bG,c- I<
Seller I-Name as appears nconveanced u eat Seller 2-Name as appears on conveyance document
a0(0 k3 ' W' IN'\ t I I �tre et
AY (N oche gd Street) 1 - 11 i to 00 Address(Number and Street)
}I/ Ir�� n t�lll Q� (J� (�1 I
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
a dd complete as req ed by law and i prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". —
NO
Signature o/Sell¢ Signature o/Seller
Dorts t.. a-I\ &el-Eacl�
Printed Name of Seller Sian Date(MM/Da/YYYY) Printed Name of Seller Sian Dare(M.M/Da/rv19
I FE BUYER(S)`/GRANTEENY061T1CAT!0EP FOR-U PROPERViiTAX4DEDUETIONSLIDENTIFYrAEIRFE-R HAVAPPOt' 1 2'
Anti Anal 41- T 1-4e 0.d
Buyer I-Name as appears on conveyance document Buyer 2-Name as appears on conveyance document
i9DL1 S' i1 ) , (Y'\ 'A OfreA -
Address(Number and Street) Address(Number and Street)
I Ok-n4het_ I NOIana 1—h tothLn _ .
FORM SALES DISCLOSURE FOI MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY.IDENTIFY ALL OF THOSE TI T PLY. H ?
YES NO CONDITION I YES NO CONDITION 4,0
0
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead ,n,-
residence? Provide complete address of primary ❑ gi 4.Sol,/p Ene / {eating/CU6�tg System
sidence,including county: ❑ ® S.Windf61 z:,, v
address(Number and Street) ❑ ® 6.Hydroelectric"b 'all I -To K A- S N t fK m a- *16 66 -', 1), soh ❑ ® 7.Geothermal Energy l jt�a/Cooling Device
City,State ZIP Code County r r4
❑ vi 2.Does the buyer have a homestead in Indiana to be n ® 8.Is this property a residentia �ntal 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: r'� below.Please see instructions for more information.
a (:) ttjovai'alhle in all counties.))/� ^/ r
Address(Number and Street) ' v-/ L 45 I D I 000.0 /.7 -oa D
City,State ZIP Code County AniporiA S / It��d
Primary property owner contact name E-mail