HomeMy WebLinkAboutHomestead_Grossman H. PREPARER
Preparsr of the Sails Disclosure Form Title
Arnie Maslanka Escrow Officer
Address (number and street, dty, state, country, and ZIP Code)
5231 Oak Grove Road, Suite A, Evansville, IN 47715
1 I. SELLER(S)/GRANTOR(S)
Seiler 1 - Name as It appears on conveyance document Seller 2- Namo as appears on conveyance document
Kimberly A. Heldt Amy Deno
Address(number and street)
2 (�0 Si) Ai Address(number and street) 2.25 6 „ i.
City, state, and ZIP Code
Fei t4-NG/ S (-0 fA-1 J/7<c VC' City,state, and ZIP Code a_ voGk,C,4C.u, ("y' yo,330
Country Country
United States of America United States of America _
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
real propertYiLf
mits or falsifies any Information required to be provided, commits a Level 5 felony.
Al / Nature of Seller J
a 1.7 6,6 1 7 1 1
Printed Name of Seller
�� Date signed (mrNddlyyyy) Printed e of Seller y
signelF1
Kimberly A_ Heldt .1O -/O- 2_ 5 , Amy Deno /a ---/
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 - Name as rt appears on conveyance document Buyer 2-Name as appears on conveyance
Amy Dawn Grossman _
Address (number and street) Address (number and street) 1
1144E600S
City,state, and ZIP Code City, state, and 71P Code 01
Fort Branch, IN 47648 /)
<"n
Country f Country ��es v �O
United States of America United States of America O4 \s
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Pursuant to IC 6-1.1-12-4, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of th -apply: i
YES NO CONDITION YES NO CONDITION �p
'Y 1
0 1. Will this property be the buyer's primary residence? A
0 3. Homestead
❑ ® 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated for ❑ ® 5. Wind Power Device
El ❑ this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
Address (number and street) 0 ® 7. Geothermal Energy Heating or Cooling Device 1
City, state, and ZIP Code County 7 6 ICI —D O 1--4--;'Li — j 0 . 'CA -1 .,_. ,. 3
-- — ---
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
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