HomeMy WebLinkAboutHomestead_Seibert H. PREPARER
Preparer of the Sales Disclosure Form Title
Pam Hancock Closer
Company
Address (number and street, city, state, country, and ZIP Code)
221 NW 5th St, Evansville IN 47708
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it ap
pears on conveyance document Seller 2 - Name as appears on conveyance ent
JOHN R. HOLLIS AND STEPHANIE S. HOLLIS, H & W
—
Address (number and street) Address (number and street) M A
904 S Center Street 1
'
City, state, and ZIP Code City, state, and ZIP Code ?0
?6,Branch, In 47648 (6
Country Country
_ Sp
ti cO�Q
E-mail address
( Q/TO
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.
Sig?tur
of Seller Signature r --7-7,WA")
Widiia;
me i ,,d Na Src er Date signed (mm/dd/yyyy) P � N me ,Seller '' ,, , Date s� n d m.d� yyyyl
. c ►l _EQ}A o l l t 3 3_- q a(o ti'' Ili , 51-411/(s
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX EDUCTIONS - IDENTIFY ALL THA APPLY
Buyer 1 - Name as it appears on conveyance document Buyer 2- Name as it appears on conveyance document
MARK ANTHONY SEIBERT AND ABIGAIL JOY SEIBERT, H & W
Address (number and street) Address (number and street)
176E795S
City, state, and ZIP Code City, state, and ZIP Code
Fort Branch, IN 47648
Country Country
Nj E-mail address
( )
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:
0 ^YES NO CONDITION YES NO CONDITION
0 O O 1. Will this property be the buyer's primary O O 3. Homestead
O.
residence? O D 4. Solar Energy Heating or Cooling System
O
O 2. Does the buyer have a homestead to be vacated O O 5. Wind Power Device 1/460, 1 ' 'y
Ni.) for this residence? If yes, provide address: O O 6. Hydroelectric Power Device •
Add ss (numbe d trees)
I Oi
� , I an ,`� � � 0 O 7. Geothermal Energy Heating or Cooling Device
3 City state, Zl code, and county
T' Under penalties of perju2_6 - iq - N -1.0s - 00 1 .2_c-8
ry, 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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