HomeMy WebLinkAboutHomestead_Bradshaw (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
219 N. Hart St., P. O. Box 13, Princeton, IN 47670
I. SELLERS)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Nancy Jones Coetta Riker
Address(number and street) Address(number and street)
699W350S 0'95 W LIDO S
City,state,and ZIP Code C/ity,�tate,and ZIP Code , f (�
Princeton, IN 47670 lJ a hi 1 - -i 0 - /( (7`s4
Country Country J
Gibson-USA usn-
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.
Signature of Seller Critp p/l Sig e of Seller
�'f nn ed Name of Seller Date signed(mm/dd/yyyy)
Pr d Namlof Sell Dat signed(mm/dd/yyyy)
Nancy Jones `4/a s/a ona Coetta Riker ' " $. 7Das'�
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 Fir—Tn.%
Rylee Bradshaw r
Address(number and street) Address(number and street)
307 Vine Street
City,state,and ZIP Code City,state,and ZIP Code APR L 9 2022
Hazleton, IN 47640 Country Country 47)2 x a. YY,/r n )
Gibson-USA GIBBON C UNTY AUDITOR
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary O 0 3. Homestead
O 0 residence'? 0 O 4. Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
0 O for this residence?If yes,provide address: 0 1:1 6. Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermalt Energy Heating or Cooling Device
City,state,ZIP code,and county ' Q Z7
- ' - 03 1 - 000- 9'-'019 _
5