HomeMy WebLinkAboutHomestead_Thomas (4) H. PREPARER
Preparer of the Sales Disclosure Form , Title
Brian K. Mahoney Attorney
Company
Address(number and street,city,state, country,and ZIP Code) '
822 E Main St., Petersburg, IN 47567 1
I. SELLER(S)/GRANTOR(S) 5 ,T
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on co Vrztyance docum
Randy Lewis Fish f ��
Address(number and street) Address(number a </l�
5 1ss` - S , 4-9'GQ E. OA.
City,state,and ZIP Code %
City,state,and ZIP Code (/Q
�'A�4-,),( G': "'-
Country I) Country le/7- 4.,
,�
United States C.,
E-mail address
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 pro ,or omits or falsifies any information required to be provided,commits a Level 5 felony.
atu Sell r Signature of Seller
L°i/
Printed Name Se er Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Randy L is Fish 1(-1 l-a 3
J. BUY (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
Linda Thomas
C"."Addrs(numband st e t�r �� Address(number and street)
Iiii
R. e
ity,state,,and ZIP Codelb _ City,state,and ZIP Code
4-7666
ountry'ICUCountry
United States
E-mail address
for certain deductions.Identify all of those that apply:
YES NO CONDITION YE NO CONDITION
dn 1.Will this property be the buyer's primary 0 3. Homestead
residence? 0 Q 4. Solar Energy Heating or Cooling System
0 ( 2. Does the buyer have a homestead to be vacated 0 E 5.Wind Power Device
for this residence'?If yes,provide address: 0 O 6. Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
,( _RI-(p_ fo Y_ tom 7 ---°°
Page 3 of 5