HomeMy WebLinkAboutHomestead_Douglas (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 #.?wfoolk
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance d ocum
eir
Lewis Enterprises, LLC 4OG ��
Address(number and street) Address(number and street) C� �,>
109 W. Locust Street �`.° �
City,state,and ZIP Code City,state,and ZIP Code 't' ‘q?
" N6
Fort Branch, IN 47648 OOi c v
Country Country T-1--�
Gibson USA 96
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.
SSii�'q/tu r of S r/. Signature of Seller
rp inte f Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Peter J. Lewis, President //1C-2 Da 2.
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
LaDonna Douglas
Address(number and street) Address(number and street)
205 W. Locust Street
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648
Country Country
Gibson USA
E-mail address
NO CONDITION
it jZr 1.Will this property be the buyer's primary ID 0 3.Homestead
O residence? 0 O 4.Solar Energy Heating or Cooling System
Sh 2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
O for this residence?If yes,provide address: 0 l) 6.Hydroelectric Power Device
Address(number and street) O O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county o?(p-18- 13- t(O c.f- co( ,3 -6, - Ca co
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 eaI property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's