HomeMy WebLinkAboutHomestead_Hardiman (22) H. PREPARER z
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent
Company
I Address(number and street,city, state,country,and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708
. I. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyaVyc ent
Christopher R.Kelley ((
Address(number and street) Address(number and street)
_ 4,4?),
831 E.State St. 36a0 54 2/// kti, 4p
City,State,and ZIP Code ✓ _ City, State,and ZIP Code
ii
Princeton,IN 47670 ��1'L,s02/L- J/(1 �<
Country 77/5— Country C'/B ��y c
US SO'vCO C \� ,
Email Address
'�'.a&o • • )
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,corr� nd complete as
required by law,a d 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 Its or sifies any innffo�rnation required to be provided,commits a Level 5 felony.
Signa f er �77 Signature of Seller
Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Christopher R.Kelley l-7 Z 7! f ,
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
Dominic K.Hardiman
Address(number and street) Address(number and street)
202 S 5th Ave
City,State,and ZIP Code City,State,and ZIP Code
Haubstadt, IN 47639
Country Country
US
Email Address
for certain deductions,Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
® 1.Will this property be the buyer's primary ® 0 3. Homestead
residence? Q IX 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 ® 5.Wind Power Device
for this residence? If yes, provide address: 0 I2 6. Hydroelectric Power Device
Address(number and street) 0 (X 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County 2�^ 12 OQ i, 00 O?7
_ 0 2,3
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