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HomeMy WebLinkAboutHomestead_Wallace (2) H. PREPARER 1 Prepa r o the Sales Di closure Form Titie Settlement Agent Company Address (number and street, city, state, country, and ZIP Code) 25 NW Riverside Drive, Suite 310, Evansville, IN 47708 I. SELLER(S)/GRANTOR(S) - Seller 1 - Name as it appears on conveyance document Seller 2 - Name as appears on conve . : d• u t Karen Shearer Address (number and street) Address (number and street) 511 S Eighth Ave /4 9 - 4e) City, State, and ZIP Code City, State, and ZIP Code J3 Haubstadt, IN 47639 <20, 6. Country Country C�/QS�4�_ -= US O'v Co - AP�� . ! Under penalties of u I herebycertifythis Sales Disclosure, to the best of myknowledge and belief, is true, correc' d complete as perjury,rY� 9 P 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. Signatur of Seller Signature of Seller I A JL Printed Name of Se er Date igned ( mldd/yyyy) Printed Name of Seller Date Signed (mmldd/yyyy) Karen Shearer r' 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 i Dorothy E. Wallace Address (number and street) Address (number and street) 5LL . e.4%04e2 v 6Cit tale, and ZIPCod City, State, and ZIP Code e / / Country Country US ( ) - 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: O YES NO CONDITION YES NO CONDITION 1. Will this property be the buyer's primary Q 3. Homestead Lresidence? ! D ® 4. Solar Energy Heating or Cooling System Dc C ® 5. Wind Power Device ` fi �' ---? X O 2. Does the buyer have a homestead to be vacated �~ for this residence? If yes, provide address: ® 6. Hydroelectric Power Device 4. '` d ss umbe and street) 03 Q (XI 7. Geothermal Energy Heating or Cooling Device 3r)(, State, and ZIP Code 1i Courtly I 1 Ll i ) e- IN) th P(D6 1 ►5g)IQ 6 " Z3 -- 06 - .© - 09o. 4 -2 0 --OO`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 i 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 Q 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//D/Other Number is necessary only if a Homestead Deduction is being filed.) 4..0