HomeMy WebLinkAboutHomestead_Leister'N. PREPARER
Preparer of the Sales. Disclosure Form
Title
DAVrl), L) F o9 mq-kSrot;1
SELL_
Company Email Address Telephone Number
b;.
09114) fi�1»ka.��• fFt�Tirl�1[ F ( ?Sly) 6-pq
Address (numberand street, city, state, country, and. ZIP Code)
S/ '02 cr'. eV'41VSu;I-C--E (7N" 2'S
1. I SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Address (number and street)
5' t ,s
Address (number and street)
O L 1N _ JZ CT,
City; State, and ZIP Code
Fv �1N -
City, State, and ZIP Code
SviL�ir QV, L S"
Country
Country
Email Address
[Telephone Number
Email Address
Telephone Number
Under;penaltiesof perjury, l•:hereby:certifythis.;SalesiDisclosure,•to:the.best_of%my=knowledge-and belief, is•true, correct, ;and complete as
required bylaw, and is.prepared"in accordance with IC: 6 1.1'=S S. Av person:::who":knowingiyand iintentionallyfalsifies;the value.of transferred
reai•prope rtyi,;or omits or falsifies.any information
required_to.be_ provided,.:commits: a;Level 5'felony.
Signature of Semler (
Signature ofSeller
Printed Name -of Seller
�i�Ui� � •ri1
Date Signed: (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
_ i�' o r✓
�f 2 e � �
.1. `BUYER(S)/GRANT:EE(S) - APPLICATION °F. FORPROPERTY TAx -DEDUCTIONS-- I DE T F A L.T A PL
ppears on conveyance document.
B�5(trr
Buyer 2 - Name as it appears.on conveyance
f 57TE
Address (number and street)
c,3 E. I Kv J i
Address (number and street)
!!;202�6
City, State, and ZIP Code
F0' 7
City, State, and ZIP Cod
Country n
Country NCO UN�aVDIrpR
Email Address [T�ele-phoM.Au be
Email Address Telephone Number
Pursuantto'IG 6 1.1,=.12-44,"the Sales-Diselosure Fonncmay besused-to-apply for certain deductions,.ldentify all of•those:-that-apply:.
YES' NO CONDITION
YES. NO CONDITION
Ef El1. Will this property be the buyer's primary
'� ❑ 3: Homestead
residence?
j.� 4. Solar Energy Heating or Cooling. System
0 Lg' : 6• Wind Power Device
❑ 2. Does the buyer have a homestead to be vacated
for this residence? If yes; provide address:
❑ [9/ 6. Hydroelectric Power Device
❑ ED/ 7. Geothermal Energy Heating or Cooling Device
aC� -13-q^"I -000, Sao-o��
Address (number and street)
City, State, and ZIP Code County
Under penalties of pequry,.l:hereby°certify thatthis Sales. Disclosure,.to--the bestiof myknowledge and`belief, is true, correct, and, complete
as.required bylaw; and is preparedimaccordance.with1C 6-1 1-5.5..A':personwho_knowinglyand`intentionallyfalsifies the value•of
transferred real property,•or omits or falsifies any :information. required to be provided, commits ra:Level`S.-felony.,(Note: Roth spouse s
information;;. SSN/Drivers:License/!D/,OtherNumber' is necessary only fa Homestead`Deduction:isbeing<filed.)
Signatul of Buyer 1 Signature of Buyer 2/Spouse
r �
Printed Legal Na e o Buy Sign . ate ( /DD . )
Printed Legal Name of Buyer Spouse Sign Date (MM/DD/YY)
G .,2
Last 5 Digits uyer 1 SSN/Drivers icense/ID/Other Number
Last.5 Digits.of B .6r 2/Spouse SSN/Driver's. License/ID/Other Number
Page 3
•
• INDIANA-SALES DISCLOSURE FORM. .
yEMPREPARERi_ _ a _ -- _ — - — • - ,' -^---r .,';' _ -
'Ray M DrUlev _ - Attorney No.4759 26-.. . • -
. `Preporer of the Sales Disclosure Form - Title - - - -
' 505.N:.Ctuicli.'street:PO Box 146 Law.Office of.Ray M. Diillev
Addreis(A'uinbeiand StieetJ Company" --
- . ' '
I Foit.B�anch;IN�47648•
812,753-4975 I druleyla v yahoo.com
City?State;and ZIP Code I , • Telephone Number I ';:E-mail: - .
. lE'::SELI ERiS)/GRANT01f* 7.. L- ^ ' "-a1z-�,-�- -5 . :r., - .'i ' .. : , .*-...1:-^.-
-r _
e.c4i-2
-
• David L Patterson
selliFi Nome as appears on conveyance document Sellerg-Name as appears on conveyance document
' 85467Mahchester Ct- .
Aadiess(Numbe'rand Street) Address(Number andsti-eet)
Evansdilje'IN 47725 .
City Stote,and ZIP Cade- I City,State and ZIP Code I
perjury,I hereby.certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct
andcoinpletc as r eggircd by la}y,"and is prepared in accordance_With IC6-1.1-5.5,"'RealProoeit Sales Disclosure Act".
. Signature of Sellir Signature of Seller , .
flavid I.'Patterson March 11 2019 .
..Printed A'ame of Seller .. ... . Siqn Date(MM/DD/YYYY) - 'Printed Naive of Seller .. . +..•.Sian Date(MH/DoryYY1). .
IT.,BUYERf TGRANITEE . 'APP:EIGATIONtEORteROP,ERULTTAXIDED.UG-TIONSbIDENTIFY/AL omEMSLTHATAPPRYi °'�---
:ScottLei tet ' ' -. " ,•... .. .. _- t -f 7..
Buyerl Aame as appears on conveyance document Buyer? Name as appears on conveyance document
— 203E John Street
Address(Numbetand Street) . • Address(Number and Street)
Fort Branch,.
E-mail Tel ephone.Number - ' 1. :.(a'/ �ZO
THE SALES DISCLOSURE FORM MAYBE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF TROSE THAT •
YES. .NO CONDITION I YES NO CONDITION. t COG •
ID '❑. 1.Will this property be the buyer's primary ❑✓-' ' n 3 Homestead •
residence? Provide complete address of primary ❑ n 4 Solar,Energy Heating/Cooling Sys$ ,<•
residence,including county. t' .0,9 ,
203 E Joli'n�Street' ❑ ❑✓ 5.Wind,Power Device
Address(Number and Street) ❑ ❑✓ 6.Hydroelectric Power Device
Fort Branch, IN 47648 Gibson ❑ `❑✓ 7.Geothermal Energy Heating/Cooling Device
City.State ZIP Code County
•
❑ " 22. Does the buyer have a homestead in Indiana to be ❑ ❑� 8.Is[his property a residential rental property?
""vacated for this r-Aidence L m
e If yes,provide ❑ f 9.'Would you,.ice 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 availdbleiri all counties.) '
Address(Number and Street)ZIP •
Code �;nr/ �- /!/
City.StateCounty N(Y - /j
/" /J_ " d- off . J90 - Da?6. .
Primary property owner contact name __ _ ��,.- -_ ,E-mail
Number License/ID/Other Number