HomeMy WebLinkAboutHomestead_Bellinger H. PREPARER
Preparer of the Sales Disclosure Form Title
Claire Kincaid Settlement Agent
Company � Email ss Telephone Number
Bosse Title Company o1 a 11.ki h Coy for e-Pr e. Lwt ( 812 ) 421-4000
Address(number and street,city,state,country,and ZIP Code)
4799 Ros d Lane,Newburgh, IN 47630
I. SELLER /GRANTOR(S)
Seller 1 —Name a it appears on conveyance document Seller 2—Name as appears on conveyance document
Jordan Thomas Nich Ison
Address(number and s t) Address(number and street)
205 N.1st St. \
City,State,and ZIP Code \ City,State,and ZIP Code
Owensville,IN 47665 \
Country Country
US
Email Address Telephone Number Email Address Telephone Number
jordanjtn17@gmail.com 1 ( 812 )217-9262 ( )
Under penalties of perjury,I hereby certify 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 transferred
e property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
i natu Iler :4_, ii/L: Signature of Seller
7
n Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Jordan Thomas Nicholson 07/09/2024 07/09/2024
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
Nicole Bellinger
re s(n mber and street) Address(number and street) ��
o - & ►movrri%vn C .
C,Ity,S e aryj Z;P rgcie�s - / 4 cp ts City,State,and ZIP Code
Country �` V I I iv
Country glib
US
Email Address Telephone Number Email Address Telephone Number
nicbellinger38@yahoo.com i ( 812 )664-0667 ( )
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 - Yj=S NO CONDITION
y
O 1.Will this property be the buyer's primary O 3. Homestead
residence? 2-11-)1- 2.02-9o0-136-o27 0 ® 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to b cated 0 ® 5.Wind Power Device
for this residence? If yes,provide addet. ress: 0 (i) 6. Hydroelectric Power Device
sy eAs(n berrstr�e9 o 0 RI 7.Geothermal Energy Heating or Cooling Device
ti
milviii 1 (Ce 0 0 4--1kne(.0 (.1? l7I bSc) ny T ease ream ow_ /himeesltead ill .0 St NI)le
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct, nd 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.(Note:Both spouse's
n ation,SSN/Driver's License/ID/Other Number is necessary only if a Homestead Deduction is being filed.) _
re of B er Signature of Buyer 2/Spouse
rin Legal Name of Buyer 1 Sign Date(MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YY)
Nicole Bellinger 7/9/2024 07/09/2024
LasA5giiisiof B er 1 SSN/Driver's Licens /I /O r Rum per Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
\oN - -002.02\.,t - SrvL n'Iwlc d'' (` vc T l r 3 ,.` , � - le)",. wt . eSinc-h1( HLS)
v%r1 11 Oc ice_ LAJ, 1( 11-0 fi tic - Ic . C1ic,, kv►toLiA 4 cio e.. Co o.n d 94\c-