HomeMy WebLinkAboutHomestead_Bailey (2)If
I'
H. PREPARER
Preparer of the Sales Disclosure Form
Title
Jerry D. Stilwell
Attorney at Law
Company
Email Address
Telephone Number
Stilwell Law Office jstilwellattorney@gmail.com
( 812 ) 386-6482
Address (number and street, city, state, country, and ZIP Code)
302 N. Prince Street, Princeton, IN. USA 47670
I. SELLERS)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Timothy D. Chamberlain
Mia B. Chamberlain
Address (number and street)
Address (number and street)
5884 W 250 S
5884 W 250 S
City, State, and ZIP Code
City, State, and ZIP Code
Owensville, IN 47665
Owensville, IN 47665
Country
Country
USA
USA
Email Address
Telephone Number
Email Address
Telephone Number
chamfarms@gmail.com
(812 ) 664-7162
(812 ) 664-7162
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 gr falsifie)9 any in r tion required to be provided, commits a Level 5 felony.
Signature of ,ram
Sig ature of Se
Printed Name of Sell4f
Date Signed (mm/dd/yyyy)
Printed game of Seller
Date. Signedmm/dd/yyyy)
Timothy D. Chamberla
2-V 741
Mia B. Chamberlain
.
J...B.UYER(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
Devyn Bailey
Krimson Bailey
Address (number and street)
Address (number and street)
1935 S. SR 65
1935 S. SR 65 CD
City, State, and ZIP Code
City, State, and ZIP Code Z
Owensville, IN 47665
Owensville, IN 47665 0
Country
Country Z W
USA
USA
Email Address
TelephoneNumber�
Email Address C
phonfourimbe
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all Of ose that apply:
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
0 ❑
0 ❑ 3. Homestead
residence?
❑ 0 4. Solar Energy Heating or Cooling System
❑ 5. Wind Power Device
2. Does the buyer have a.homestead to be vacated
F-
= for this residence? If , esprovide address:
Y P
,.
❑ ❑ 6. Hydroelectric Power Device
❑ " ❑ 7. Geothermal Energy Heating or Cooling Device
Address (numb�,� ap4 street)..
64c -lQ) . ti �l o - �
city, St te, d ZIP Code / t � Count
"� , ,r <Q /�.� 2� �13 y
Under penalties of perjury, 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
information, SSN/Driver's License/ID/Other Number is necessary only if a Homestead Deduction is.being filed.)
Signature r 1
Sig at e of Br 2/gyp use
Printed Legal'Name of Buyer 1 Si n D to (MM/DD/YY)
Printed Legal Name of Buy r 2/5pouse Sign Date (MM/DD/YY)
Devyn Bailey '
Krimson Bailey
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
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