Loading...
HomeMy WebLinkAboutHomestead_Kohlmeyer 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, Princeton, IN 47670 I.SELLER(S)/GRANTOR(S) Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document Malcolm L. Russelburg Living Trust Address(number and street) Address(number and street) pi. 5778 S 650 E Rd City,state,and ZIP Code City,state,and ZIP Code Francisco, IN 47649 4.1.1) CouleeY Country 400 0 c of my knowledge an&i5�ts(u •rrect and complete as required by law,and Is prepared In accordance with IC 6-1.1-5.5.A person who knowingly and Intentlo11R T •-value of transferred real pro My,or omits yfaisifles an formation required to be provided,commits a Level 5 felony. q/� ' , Sig?. of Sell r ;' a Signature of Seller ©'rpA Printed Name of Sefler D. e'-.n-d mm/d y) Printed Name of Seller Date signed(mm/dd/yyyy) Malcolm L. Russelburg,Trustee Q', a 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 Justin H. Kohlmeyer Andrea C. Kohlmeyer Address(number and street) • Address(number and street) 6388 W Old Princeton Rd 6388 W Old Princeton Rd City,state,and ZIP Code City,state,and ZIP Code Owensville,g IN 47665 Owensville, IN 47665 llll C�gtAry • . Coat Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for cer'ain deduc ons.Identify all of those that apply: I YES NO CONDITION YES NO CONDITION 1,Will this property be the buyer's primary 0 0 3. Homestead a' O 0 residence? • 0 C) 4.Solar Energy Heating or Cooling System _ 6) 2. Does the buyer have a homestead to be vacated 0 C) 5.Wind Power Device dilI 0 for this residence?If yes,provide address: 0 () 6.Hydroelectric Power Device OO Address(number and street) 0 () 7.Geothermal Energy Heating or Cooling Device -r- 6388 W Old Princeton Rd C),-, City,state,ZP code,Owensv Ile,l N 476an county d 2-6— Lp -?R-I OO- )o2 ,O 2..-2. ( ••••••�p 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/Drtver's Llcense/ID/Other Number is necessary if a Homestead Deduction is being flied.) :: . w } YI Page 3of5 ; K C ;+r