Homestead_Kiesel H. PREPARER
Preparer of the Sales Disclosure Form Title
Lindsay M. Phelps Searcher
Company
Address(number and street,city,state,country,and ZIP Code)
226 W Broadway, Princeton, IN, USA, 47670
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance dovimr.nt Seller 2-Nagle as,appears on conveyance document
Tonja L.Beuligmann,P.O.A for Harold L.Coleman;
I onti& L JpeAwirvt4nn P o A -C-o v-- Sharp n (,..C.cit-frvf-x—)
Address(number and street) Add ess(number antlistreet) /
P.O. Box 361, 151 N Church St P 0. i&n#0-.7t.it I j Si /3 0_,t-1/. , CI-/ ST
City,state,and ZIP Code ity,state,and ZIP Code _
Poseyville, IN 47633 1, vi lie-- `. --)\1 4-7433
Country ounte.
USA LT
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.
Sign lure of Seller , . \.
0A ay
Signature of Seller
P ,
Printed ame of Seller Date signed(mm/dd/yyyy) Printe ame of Seller , Date signed(mm/dd/yyyy)
Torea I-Saulqnnann.P 0.A for ninon,Coleman anal Shawn l-Coleman _.I Li-
Ti
-1-771:1i et,Z.,/3e..-i-e-?i rn...e.,rs 0 0 0'4-- /-/4/-
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAYDEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
Larry J. Kiesel Diane S. Kiesel
Address(number and street) Address(number and street)
8694 S 450 W 8694 S 450 W
City,state,and ZIP Code City,state,and ZIP Code
0 Owensville, IN 47665 Owensville, IN 47665
( Country Country
USA USA
0 c E-mail address Telephone number E-mail address Telephone number >-
( ) ( )
- Es
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply: 4
a YES NO CONDITION YES NO CONDITION ca—
‹.;) 0 3.Homestead L?i ¢
r21 CI 0 0 1.Will this property be the buyer's primary
residence? 0 0 4.Solar Energy Heating or Cooling Syster0
I -sr )
cz 7
-) (8( r-t. 2. Does the buyer have a homestead to be vacated 0 121 1—II 5.Wind Power Device . -.-- 0
'-'''' for this residence?If yes,provide address: 0 WJ 6.Hydroelectric Power Device
(1)
-r. - rIcs4nnber and sir 0 21 7.Geothermal Energy Heating or Cooling Device co
(20 Lr Cz, NNO it 1 E 5
(...... glity,state,and Co.we__,______.— / Cguaty( 26-18-36-401-000.620-009
l L')CU E---77kNil / r LAI 21-76AS— '6 6W,
Under penalties of perjury,-1 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
.........
1. transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
information,SSN/Driyer's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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