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HomeMy WebLinkAboutHomestead_Smith (4)H. PREPARER I Preparer of the Sales Disclosure Form —_Title 11 Company Email Address Telephone Number w , ,ar..., rrin i i r I orrlAmOhnmPtowntitlPa mm I ( 812 ) 461-6399 Address (number and street, city, state, country, and ZIP Code) 25 NW Riverside Drive, Suite 310, Evansville, IN 47708 1. SELLER(S)IGRANTOR(S) Seller 1 - Name as It appears on conveyance document James R. Bickel Address (number and street) City, State, and ZIP Code Country us r-i7 Email Address Telephone Number Under penalties of perjury, I hereby certify this Sales disclosure, to required by law, and is prepared In accordance with tG 6.1.1-5.5. A I real property, or omits or falsifies any Information required to be pr Seller 2 - Name as appears on conveyance document Hyacinth B. Bickel Address (number and street) r City, State, and ZIP Code Country us Email Addr ss ephone Number F st of my knowledge and belief, Is true, correct, and complete as on who knowingly and intentionally falsifies the vatuq of transferred tied, commits a Level 5 felony. Signs r of Seller �r ^, Printed Name of Seller Dale Signs (mm/dd/yyyy) Print ame of Seller Date Signed (mm/ddlyyyy) James R. Bickel H firth B. Bickel %�` - J. 13UYER(S)IGRANTEE(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 C nthia D Smith Address (number and gtreet) r f r, Address (number and street) City, St", art, dZIP Coq, y�� j f City, Stale, and ZIP Code V, yy Country Country t. us Email Address Telephone Number Email Address Telgpttan` bar S t AC C(' ) -' p i) Pursuant to IC -1.1-12-44, the Sales Disclosure Fomr may be used to apply for certain deductions. Identify all of those that apply: YES NO CONDITION YES NO CONDITION 1, Will this property be the buyer's primary ® 0 3. homestead r( NOn�T 29 O D residence? 0 ® 4. Solar Energy He 6%% V6oGoling System If O 2. Does the buyer have a homestead to be vacated 0 (9 5. Wind Power Device for this residence? If yes, provide address: 0 3 6. Hydroelectric Power Device Address (number and street) © ® 7. Geothermal Energy Heating or Cooling Device City, State, and ZIP Code County 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 lnforrnatlon, 3 is License11010ther Number is necessary only Ufa Homestead Deduction /s being Mod,) Signatu Signature of Buyer 2/Spouse Pr me of Buyer 1 Sign Date (MM/DD Y) Cynthia D Smith Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY) Last 5 Digits or Buyer 1 SSN/Driver's License/ID/Other Number last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number Page 3