HomeMy WebLinkAboutHomestead_Brimhall H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers Escrow Officer
Company
Address(number and street,city,state,country,and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears on conveyance document
Lilco, Inc., an Indiana corporation
Address(number and street) Address(number and street)
304 Valleydale Dr.
City, State and ZIP Code City,State and ZIP Code
New Albany, IN 47150 '
Country
Country
United States of America
E-mail address telephone number E-mail 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.
i nature of Seller Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller f Date signed(mm/dd/yyyy)
Evelyn M. Lilly, President
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance document
Sharon Brimhall
Address(number and street) Address(number and street)
720 Perry St,Apt 3
City, State and ZIP Code City, State and ZIP Code
Vincennes, IN 47591 '
Country Country
United States of America
E-mail address •
for certain deductions.Identify all of those thCZ : or
INO CONDITION YES NO CONDITION C.4 a
0 1. Will this property be the buyer's primary residence? 0 3. Homestead c�
❑ El 4. Solar Energy Heating or Cooling yste '-rZ N
❑ 2. Does the buyer have a homestead to be vacated for this ❑ El 5. Wind Power Device ^' E
residence? If yes,provide address: (.......3 O
❑ El 6. Hydroelectric Power Device w 0
Address(number and street) 0 El 7. Geothermal Energy Heating or Co 'n Devices 0O
O_
City, State,and ZIP Code County r� p- O V,` -3C p- yy�e2, 2 79 2D
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.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.(Note:Both spouse's information,SSN/Driver's
License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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