HomeMy WebLinkAboutHomestead_Hollis (2) 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. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document Seller 2 - Name as appears on rvey n docu
MARK A. SEIBERT AND ABIGAIL J. SEIBERT, H & W
Address (number and street) Address (number and street)
176 E 795 S _ MAR 2
City, state, and ZIP Code City, state, and ZIP Code 2026
Fort Branch, In 47648 I
I
Country Country 124 ` G[ I
GIOSON 1
C 4
E-mail 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.
Signa e of Sc e- % ' Si ature of Sell
_ . -7--#, _ . 3)q/L3?
Printed Name of eller Datgsigned (mm/dd/yyyy) Printed me of Sel Date signed (mm/dd/yyyy)
MARK A. SEIBERT "-V1/ - ABIG IL J. SEIBERT
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
JOHN RAY HOLLIS AND STEPHANIE DAWN HOLLIS, H & W
Address (number and street) Address (number and street)
904 S Center Street
City, state, and ZIP Code City, state, and ZIP Code
Qp Fort Branch, In 47648
C\ Country Country
0
/ E-mail address
( )
NIPursuant 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:
YES NO CONDITION YES NO CONDITION
•
1. W:II this property be the buyer's primary 0 O 3. Homestead
0� O O residence?
O O 4. Solar Energy Heating or Cooling System
O O 2. Does the buyer have a homestead to be vacated 0 CD 5. Wind Power Device
for this residence? If yes, provide address: 0 O 6. Hydroelectric Power Device )0 ,
Address (number andstreet)l ( u ber st ee ) ❑ 0 7. Geothermal Energy Heating or Cooling Device
S 176E795S
( City, state, ZIP code, and county
0-- Fort Branch, In 47648 ..( - ICI - M — 10 . —000- 0 O -026
-- —
k Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete
�1) 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 O transferred real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note: Both spouse's
_,
Page 3 of 5