Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Homestead_Peech
H. PREPARER Preparer of the Sales Disclosure Form Title Patti Doyle Escrow Officer Company Address(number and street, city,state, country,and ZIP Code) 41 East Washington Street, 400, Indianapolis, IN 46204 I. SELLERS)/GRANTOR(S) • Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on cony ce document Roger Whitehead Address(number and street) Address(number and street) 1772 East Giro Road 14,61 City,State,and ZIP Code City,State,and ZIP Code I Hazleton, IN 47640 J �� Country Country 1�O� e ' United States of America 0/ 3 of my knowledge and belief,is t1dob t and complete as required by law,and Is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and Intentionally falsifii� a value of transferred 5?- 1real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. Sign ture of Seller , t i Signature of Seller ,4, Printed'Name of Seller Dare Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy) Roger Whitehead i >, , 20_n , 20__© 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 James Peech Address(number and street) Address(number and street) 1772 East Giro Road City,State,and ZIP Code City,State,and ZIP Code Hazleton, IN 47640 -- Country Country United States of America 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: YES NO CONDITION YES NO CONDITION � I—I 1.Will this property be the buyer's primary ¢ ❑ 3. Homestead lXJ I I residence? ❑ iggi4.Solar Energy Heating or Cooling System j 2. Does the buyer have a homestead to be vacated Ell d 5.Wind Power Device ri I�,J for this residence? If yes, provide address: ❑ li 6. Hydroelectric Power Device Address(number and street) ❑ IN 7. Geothermal Energy Heating or Cooling Device 'City,State,ZIP code,and County a6- 02 8-101-000.16ct- 018 . Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete Y � f � a