HomeMy WebLinkAboutHomestead_DIlbeck (4) H. PREPARER
Preparer of the Sales Disclosure Form Title
Shannon Valiant 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 convey c ocument
Samantha Beadles
Address(number and street) Address(number and street)
6289 S 1050 W s,
City, State and ZIP Code City, State and ZIP Code
Owensville, IN 47665 Cz9 V6'?
Country Country O,L- ��!) \\
United States of America CO
Email Address Address 4iy. Telephone
Under penalties of perjury, I hereby certify this Sales Disclosure,to the best of my knowledge and belief, is true,corf 9t 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.
Si 4ure of Seller Signature of Seller
V)11,Yoki .. 2?
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Samantha Beadles 8/29/2023
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIF A Y
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it app ar c d ument
Cole Dilbeck
Address (number and street) Address(number and stree6UG 31 2023
9ce1 W, goo 5,
City, State and ZIP Code City, State and ZIPL�
Country •
.�SJ)u C— ll� ?�o S CountryGIBBON COS IN y A b,&�)�
United States of America
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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
tit 0 1. Will this property be the buyer's primary residence? ,!.' 0 3. Homestead
0 4. Solar Energy Heating or Cooling System
❑ .Igt 2. Does the buyer have a homestead to be vacated for ❑ 5. Wind Power Device
this residence? If yes, provide address:
0 II 6. Hydroelectric Power Device
Address(number and street) ❑ p 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county (� r-�
- -I-1 -06 - i on- nno •�J I �-o � I
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
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