Homestead_Dersch H. PREPARER
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
219 N Hart St, PO Box 13, Princetoh, IN 47670
I.SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Tim I. Davis
Address(number and street) Address(number and street)
144 E 795 S
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648
Country Country
gibson
1
my knowledge and belief,is true,correct and complete as
required by law,%an i repared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
realm:,,Fty ,. , t or falsifies any information required to be provided,commits a Level 5 felony.
N6Wrgs.— t f'S ''''7 Signature of Seller
Printed Name of Seller Date signed(mmIddlyyyy) Printed Name of Seller ate signed(mm/ddlyyyy)
Tim I. Davis 032025
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL T
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears onitippyance document '
Heleana Dersch r 2 5 <9025
it_ Address(number and street) Address(number and et),
, 218 W Dale St
LI Giao
0 City,state,and ZIP Code City,state,and ZIP Code`JOAr;fecO
t Oakland City, IN 47660 . //i..
„.„.... Country Country 01(in-`4"024)
`-oolt?
-,..-..;\ gibson
cxlif.
apply for certain deductions.Identify all of those that apply:
0 YES NO CONDITION YES NO CONDITION
( r, 1.Will this property be the buyers primary 0 0 3. Homestead
residence? 0 0 4.Solar Energy Heating or Cooling System
cr) 2 , 2. Does the buyer have a homestead to be vacated 0 E 5.Wind Power Device
1 ' for this residence?If yes,provide address: 0 C) 6.Hydroelectric Power Device
0Q Address(number and street) 0 E 7.Geothermal Energy Heating or Cooling Device
7 218 W Dale St
City.state,ZIP code,and county
0— Oakland City, IN 47660 Z -7X)3,-100‘ .2_SI -
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
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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