HomeMy WebLinkAboutHomestead_Newcomb H. PREPARER
Preparer of the Sales Disclosure Form Title
Christa D. Tracey Escrow Officer
Company
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard. Evansville IN United States of America 47713
-41
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document Seller 2 - Name as it appears on nyt ce d lent
Brett Seibert Lacy Seibert
Address (number and street) Address (number and street) pees
1)
12646 S 200E 12646 S 200E
City. State and ZIP Code City, State and ZIP Code, . 6'
Haubstadt, IN 47639 Haubstadt, IN 47648 O/ems
Country Country �CoO�'
United States of America ti
United States of America 4U
Email Address
)
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 property, or
omits or falsifies any information required to be provided, commits a Level 5 felony.
Signature of Seller '1 • i Signature of Seller 4
+
Printed Name of Seller Date Signed (mm/ddi Printed Name of Seller d Date Signed (mm/dd/yyyy)
Brett Seibert YYYY) Lacy Seibert
/q - )v.)t J - 1 S -c.20, Rc40
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
Shalonda Maree Newcomb John Perkins
Address (number and street) Address (number and street)
913 Mohawk Dr. 913 Mohawk Dr
City. State and ZIP Code City. State and ZIP Code
Fort Branch, IN 47648 Fort Branch, IN 47648
Country Country
United States of America United States of America
`0 Email Address
a ,
t 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:
`-.1 YE NO CONDITION YES O CONDITION
" ❑ 1 . Will this property be the buyer's primary residence? ❑ 3. Homestead
7
❑ 2. Does the buyer have a homestead to be vacated for
❑ Ei. Solar Energy Heating or Cooling System
9 this residence? If yes, provide address: L7 5. Wind Power Device ; �''
Address (number and treet) ❑ �6/ Hydroelectric Power Device
C �_ �, ❑ C1✓7. Geothermal Energy Heating or Cooling Device
iockkk,• V_, 0 v
pQ City, t and ZNIP Code i County
I \I_DC‘- 061 \ ---al kA -1 f' ' ,. (0 — ? ! ( Lk 0 0 - 0 00, 9-1- --c)2_.
C-, 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
k re . ed by law, and is prepa din accordance with IC 6-1 .1-5.5. A person who knowingly and intentionally falsifies the value of transferred real
operty, or omits or falsifieany information required to be provided, commits a Level 5 felony. (Note: Both spouse's information, SSN/Driver's
Licenc/lD/Other Number i ecessary if a Homestea Deduction is being filed.)
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