HomeMy WebLinkAboutHomestead_BullockH-:PREPARER, .
Preparer of the Sales Disclosure Form
Title
Daniel L. Siewers
Attorney at Law
Company
HartBell, LLC
Email Address
dseiwers@hartbell.com
Telephone Number
(812 ) 882-8935
Address (number and street, city, state, country, and ZIP Code)
513 Main St., Vincennes, IN 47591
I: 'SELLER(S)/,GRANTOR(S): `
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
The Charles L. Mayfield Revocable Trust dated 10-9-2024
Charles L. Mayfield, individually
Address (number and street)
Address (number and street)
3366 W. 200 S.
Same
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Country
Country
USA
Email Address
LTelephon—eNum—ber
Email Address
Number
) 664-1415
7TeIephone
) 664-1415
Under penalties of perjury; l; hereby'certify:this Sales,,Disclosure, to the best:of myknowledge<and'beliefjs true, correct, and complete as
requiredby law, and+is prepared>inaccordancewith IC, 6 1 1=St& A persomwho,knowingly°and"intentionally falsifies the value.of transferred'
realproperty;oromits: :orfalsifies.anyinformation. .required,tobe:provided,,comm its a',Level!s.felony. -
Sign ttt of eller n Signature of Seller
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Charles L. Mayfield, Trustee
Lr V/�
Charles L. Mayfield, individually
J. BUYER(S)%GRANTEE($) — APPLIGATION FOR PROPERTY'TAXFDEDUCTIONS°-FIDENTIF<Y ALL THA . CY
-
Buyer 1 —Name as it appears on conveyance document
Buyer 2 —Name as it appears on conveyance doc
Devon Walter Bullock
o
Address (number and street)
Address (number and street)
3277 S. 350 W.
�-
City, State, and ZIP Code
City, State, and ZIP Code e�e�
Princeton, IN 47670
Country
Country
USA
Email Address
Telephone Number
Email Address
Number
7Telephone
)
Pursuantzto,IC 6-1.1A244, the -.Sales Disclosure: Form may bee,usedlo
apply°for certain deductions.. Identify, all'of'those.that apply:
YES NO CONDITION
YES NO CONDITION
® O 1. Will this property be the buyer's primary
O✓ O 3. Homestead
residence?
O OO 4. Solar Energy Heating or Cooling System
O (2) 2. Does the buyer have a homestead to be vacated
O O✓ 5. Wind Power Device
for this residence? If yes, provide address:
O O✓ 6. Hydroelectric Power Device
❑ CO 7. Geothermal Energy Heating or Cooling Device
.2z- /200 ` lcy, , ��� r D� r7
Address (number and street)
City, State, and ZIP Code County
Under penalties of pequryj hereby: certify this.Sales;Disclosure,.to_th6�best of:mv,knowledge;and bUehef, s frue; correct;:and complete
as,require&bylaw,`and is prepared in,accordance..with ICc6A.1=5X.-A person-,wlio knowingly and lintentionally4alsifies the.. value of
transferred.real>property, or omits or falsifies any Jnformation required.to be provided,, commits a1evei 5,felon y:,(Note: Both spouse's
infonnation;. SSN/Driver'slicense IDLOther Number -is necessary only if a 'Homestead Deduction is, being filed)'
Signature of Buyer 1 Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date/ (MM/DDNY)
Devon Walter Bullock UL� l I U I dA_.Q
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
5aj,U
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