HomeMy WebLinkAboutHomestead_Larson J
H. PREPARER
Preparer of the Sales Disclosure Form Title
Timothy Shea Processing Coordinator
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd Ste 201,Evansville,IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Cindy Kay(Flaningam)Koontz
Address(number and street) Address(number and street)
803 S Hall Street
City,state,and ZIP Code City,state,and ZIP Code
Princeton,IN 47670
Country Country
E-mail address , 1 E-mailyi9lhpuit.) address Telephone number
fi�l
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.
Sig fure of Seller Signature of Seller
Printed Name of S : I��,ate signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Y
Cind Kay(Flaningam)Koontz .3/05/21 03/05/21
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
1
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
Kyla M.Larson
Addres (nurnber-apd street) Address(number and street)
WS
Vittate,and ZIIP--}}t►Ct�►odpe� City,state,and ZIP Code
• � -tt� , 1N u'l1J1O
Country t1V ill` Country
E-mail address
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be use to apply for certain deductions.Identify_all of those that apply:
0YES NO CONDITION YES NO CONDITION
07
r f O 1.Will this property be the buyer's primary 0 3.Homestead Z
}�' residence? O 03
4.Solar Energy Heating or Cooling System o - -, F
Ori 2.Does the buyer have a homestead to be vacated 0 155.Wind Power Device z N L
for this residence?If yes, provide address: 0 0 6.Hydroelectric Power Device D
I Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling De C
O
lt
City,state,and ZIP Code County xi
26-12-18-101-002.603-028 W
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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