HomeMy WebLinkAboutHomestead_Hale (2)I
H. PREPARER
Preparer of the Sales lDisclosure Form
Title
Pamela Partenheimer Mick
Attorney
Company
E-mail address
Telephone number
Partenheimer, Kinkle & Partenheimer Mick
pameia@pkpmlaw.com
(812) 3$60050
Address (number and street, city, state, country, land
ZIP Code)
219 N Hart St, PO Box 13, Princeton;
IN 47670
I: SELLER(S)IGRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Justin H. Kohlmeyer j
Andrea C. Kohlmeyer
Address (number and, street)
Address (number and street)
5778 S 650E
5778 S 650 E
City, state, and ZIP Code
City, state, and ZIP Code
Francisco, IN 47649
Francisco, IN 47649
Country
Country
us I
us
E-mail address
Telephone number
E-mail address
Telephone number
( ) 812-431-5504
( ) 812-598-0993
Under penalties of perjury, I hereby. certify this Sales Disclosure, to the best of my.knowledge and:belief, is true, correct and complete as.
.required by law, and. is prepared in accordance withIC 6-1.1-5.5. A person who: knowingly, and. intentionally falsifies the value of transferred `
real property, or omits or falsifies any information required W be. provided, commits a Level 5 felony.
Signature of Seller
i
Signature of Seller
ri ame r
Date signed (mm
PNnted Name of Sel er
Date signed (mm/dd/yyyy)
Justin H. Kohlmeyer
,$ ern
Andrea C. Kohlmeyer
65 Ido l I 207-co
J..BUYER(S)MRANTEE(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
Michael Hale
Kaci Jo Hale
Address (number and street)
Address (number and street)
1580 S Old Sr 65
1580 S Old Sr 65
City, state, and ZIP Code 1
City, state, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
us
us
E-mail address
Telephone number
E-mail address �6is Telephone nu
812-664-
( i ) 812-664.6634
Pursuant to IC 6-1.1=12-44; the Sales Disclosure Form may be used to apply for certain deductions. Identify all o . mat apply:
YES NO CONDITION
YES NO CONDITION
O O 1. Will this property be the buyer's primary
!
O O 3. Homestead 3�k
4. Solar Energy Heating Cooling
residence?
O O or
O O 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
O
for this residence? If yes, provide address:
O CD6. Hydroelectric Power Device
O O 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
1
1580 S Old Sr 65
� 18 �cz)-- OC6 U� ,
City, state, ZIP code, and county
1
Princeton, IN 47676
Under penalties of perjury, l 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 accord ancemith IC 6-1.1w55. A perso.n:who knowingly and intentional ly falsifies the value of
transferred. real or omits.6r falsifies any information required to be provided,commits a' Level; 5 felony: (Note: Both spouse's
info rmadorj SSN/Driver's License/iD/Other Number is necessary if a Homestead Deduction is being filed.)
Si tur Bu r 1 I
y _ C�5 O� ��
Si n ture of Buy a 2/S use
J. -
Printed Legal Name of Buyer 1 Sign Date.(MM/DD/YY)
Printed Legal Name of Buyer 2iSpouse Sign Date (MM/DD/YY)
1 Michael Hale I
Kaci Jo Hale
Last 5 Digits of Buyerjl SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer2/Spouse SSN/Driver's License/ID/Other Number
3 5 `7 2 1
15 u
Page 3 of 5
EP,