Homestead_Hollander H. PREPARER
Preparer of the Sales Disclosure Form Title
Kris Coon Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave., Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1-Name as It appears on conveyance document Seller 2-Name as appears on conveyan document
Tom Black
ss( er street) {{ Address(number and street)
4_1
it . to P o City,state,and ZIP Code
44/
CcKa‘ Country
6 w+
of my knowledge and belief,tilt rrect and complete as
required by law,and Is prepared In accordance with IC 6-1.1-5.5.A person who knowingly and intentionally f e value of transferred
real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony. /)OR
Signet u '�L � Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date si a dd/yyyy)
Tom Black / ^22--25/
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
Sarah C. Hollander Jordan R. Hollander
dEt mEan` 'e rt i t t i Address(number and street)
rrarer.n
� (0+9 City.sla and ZIP Code
Country 1�\I f►\"l Cou
U_Sinc
YES O CONDITION
f 6� D 1.Will this property be the buyer's primary D 3. Homestead
— residence? 0 4.Solar Energy Heating or Cooling System
` 2. Does the buyer have a homestead to be vacated D YJ 5.Wind Power Device
g
us D for this residence?If yes,provide address: Q 54 6. Hydroelectric Power Device
i
O r (nvmyer*Qttre ry h, 0 7.Geothermal Energy Heating or Cooling Device
l N A(
cou ty' 1 [�
21 71tIntoIle,,and
c,� v 1J ��� 7 D6-1'1- k --2_ o -001 - 8sk -eot1
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
(Nn 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
Page 3 of 5
, t Xy #.`
_,i, .:c am
s CLAIM FOR HOMESTEAD PROPERTY TAX YEAR )
Iiis STANDARD/SUPPLEMENTAL DEDUCTION FORM 1
c ;r State Form 5473(R 19/1-23) HC1g [a o a
:r—, Prescribed by the Department of Local Gevemme,- ,J
INSTRUCTIONS:See reverse side for filing instructions
NOTE Telephone,Social Security,driver's license.state identification and federal identification numbers are confidential under IC 6-1 1-12-37.
CERTIFICATIONE1 STATEMENT
I(We) • Os �h "1— 4 Vs 4 o k G. e_. certify tnat I(we)occupied as my lour)principal place of (7).5
\
residence or am(are)buying the following escnbeed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date t is application is signed. — .a (date of signature) I(We) p 1
Own El Am rare'buying under recorded contract
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence bust
Am(are)the shareholder,partner,or member of the entity that owns the property
If Buying on Contract�Feeeeee Simple Owner's Name
tJ • - —
Recorder's Office here Contract is Recorded I Record Number Page
PROPERTY DESCRIPTION a'
County Township ." - laty •_... __
es?
bsQr� C'_e--t- -P.r'• - ----
Parcel Number Legal Descnphan is the property in question T Property 0 Annually Assessed Motile Horne(IC 6-1 1-7) V \eat
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income describe the use and portion
of the property ut'l¢ed to produce income
>
PROPERTY OWNED ELSEWHERE BY CLAIMANT II w-
State.County,and Township Is Claiman eating a Homestead'/ °*...---7 c• V
i No
LAI
_- $'gnat C' ima^.t J
hereby certify the above statements are true.correct,and complete •tx/
IAddress of Contact(number and street.city st a and Z P Address of Vacated Homestead if any(number and street city.state and ZIP code ��
y1 �- �-- d • `--1 -ran . L+-I • LA Ul v - • 1:
ASSESSOR USE ONLY ASSESSED VALUE 1 HOMESTEAD VALUE NON-RESIDENTIAL VALUE ^ i1 _
Land Not Exceeding One(1)Acre Immediately (1) (�` �JJ
Surrounding Residential Improvement l
Other Land (2)
Total Land(line I plus line 2) (3) F
TResidential Improvements or Dwelling (4) 1
Annually Assessed Mobile I r
Manufactured Home I Garage (5) ED
Other Improvements (6) FEa A
Total Improvements(Line 4 through Line 6) (7) 9 2024
Total Value(Line 3 plus Line 7) (8) I
y�: t
Signature of Assessor G�3ON CO CO.. nod(date year)
I hereby certify the above is true,correct.and complete. UN/Ty
qUn/rr//'',�....
Verifying Action-Signature of Auditor Date SigrfeS(date month,year)
STANDARD DEDUCTION ALLOWANCE (n
�.
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548 000 \ `-'
Illi
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1 1-12 to a mobile Home that S \ \
is not assessed as real property or to a manufactured home that is not assessed as real property may not \ t�
exceed one-hall(1/2)of the assessed value of the mobile home or manufactured home �/\
Signature of Auditor Date Signed(/);d yea)
JAL
DISTRIBUTIO noire]-County Auditor File-Stamped Copy-Taxpayer \
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