HomeMy WebLinkAboutHomestead_Manson H. PREPARER
Preperer of the Sales Disclosure Form ' hue
Arnie Meslenke { Escrow Officer
Company
Address (number and street, city, state, country, and ZIP Code)
5231 Oak Grove Road, Suite A, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S) -&tt--4b/ .
Seller 1 -Name as tt appears on conveyance document 1 Seller 2-Name as appears on as ance document
Tyler Bolen _- Cassidy Rose Bolen 'C[
Address (number and street) Address (number and street) ' 2O
852 Northwood Ave 852 Northwood Ave
City, state, and ZIP Code I City, state, and ZF Code&SQ� Q
Jasper, IN 47546 C
Pe Jasper, IN 4754$ OUP, • ,.L
Country Country T�°}''qt JQ,�Z,
United States of America United States of America _ OR
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.
Slgnsture of Seller T--- 7' u
Signature of Se1ie�}"\ :�
.Lq iff)k-e-04\
Printed Name of Seiler I Date igned (mm/dcllyyyy) Printed Name of Seiler ( I Date signed (mrtVddVYYYY)
Tyler Bolen E i -- -ID, a.s Cassidy Rose Bolen ' 1 II- Z.o.
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 appears on conveyance document
Rashell Manson -
Address (number and street) Address (number and street)
10127 E. Tennessee St
City, state, and ZIP Code City, state, and ZIP Code
Oakland City, IN 47660
Country Country
United States of
for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 3. Homestead
0 1. Will this property be the buyer's primary residence? 0 IN 4. Solar Energ
y Heating or Cooling System
❑ Am 2. Does the buyer have a homestead to be vacated for 0 IN 5. Wind Power Device
this residence? If yes, provide address: ❑ B 6. Hydroelectric Power Device
Address (number and street) 0 ® 7. Geothermal Energy Heating or Cooling Device
City, state,and ZIP Code County
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
i ? i