HomeMy WebLinkAboutHomestead_HollingsworthH. PREPARER
Preparer of the Sales Disclosure Form `®�_dale
Abbigail Jarvis Est ra•,:v Officer
Company E-mail address Telephone number
Southwestern Indiana Land Title (812) 425-0055
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville 1N United States of America 47713
1. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 --Name as it appears on conveyance document
Estate of James Paul Beraglia aka James P. Beraglia
Address (number and street)
Address (number and street)
406 W Spruce St
'
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Country
! Country
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
-S75;' - q (00
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 IG 6A.1-6.5. 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.
ignature o Seller ,
LZ.Lt(AY,of at, La
J�J
Signature of Seller
Printed Name o Seller
Date Signed..(mm/dd/ .
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Daniela Bogart, Personal Representative
yyyy)
J. BUYER(S)/GRAN T EE(S) •-APPLICATION FOR PROPERTY TAX DEDUCTIONS IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document
; 8uyer.2 •- Name as it appears on conveyance documerrt
Shaun Hollingsworth
Address (number and street)
Address (number and street
406 W Spruce St.
,,.
iCity,.Siate
_.j
City, State and ZIP Code
and ZIP Code
Princeton, IN 47670
1,
Country
Country IT2
8
United States of America
00 M
Email Address
dre s
Telephone Number
Entail Address /6SON
Telephone Number
rdahoo.com
@y
(812) 664-1148
C Q
O
Pursuantto IC 6-1.1-12-44, the Sales Disclosure Form maybe used to apply for certain deductions. Identify af hat apply:
YES NO CONDITION I
YES NO CONDITION TOh,
❑ 1. Will this property be the buyer's primary residence? !
0 3. Homestead
❑ Q 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for ;
this residence? If yes, provide address:
❑ 0 5. Wind Power Device
❑ Q 6. Hydroelectric Power Device
Address (number and street) )
E❑
❑ 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
11
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and comple a as
required by law, and is prepared in accordance with IC S-i.1.5.5. A person who lulowingly 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 information, SSN/Driver's
LIcenseAD/Other Number is necessary if a Homestead Deduction is being irlea )
Signatur of B
er 1
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date (MMIDD/YY) i
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Shaun Hollingsworth 4127/2026
�^ - jI
Last 5 Di its of Buyer 1 SSN/Driver's LicensellD/Other Number i Last. 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
SSN: 01
Page 3