HomeMy WebLinkAboutHomestead_WilderH..PREPARER
Preparer of the Sales Disclosure Form
Title
Daniel A. Moon
Attorney
Company
Email Address
Telephone Number
Daniel Moon Law Office, LLC
danielmoonlaw@gmail.com
(812 ) 385-1843
Address (number and street, city, state, country, and ZIP Code)
111 N. Hart Street, Princeton, Indiana 47670
L. SELLER(S)IGRANTOR(S).
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Derek Anderson and/or Daniel A. Moon
Address (number and street)
Address (number and street)
5805 Wooden Cleek Drive
City, State, and ZIP Code
City, State, and ZIP Code
Shorewood, MN 55331
Country
Country
USA
Email Address
Telephone Number
Email Address
Telephone Number
danielmoonlaw@gmail.com
(812 ) 385-1843
( )
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, andisprepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of transferred
rea grope or miK falkifies any Information required. to be provided, commits a Level 5 felony.
Sig re of Se r
Signature of Seller
Printed Name of Seller
Date igne (mmldd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Daniel A. Moon
� �ZJ 20 ZC.e
J. BUYER(S)/GRANTE.E(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
Donald K. Wilder
Mary Ann Wilder
Address (number and street)
Address (number and street)
910 N. West Drive
910 N. West Drive
City, State, and ZIP Code
City, State, and ZIP Code
Oakland City, IN 47660
Oakland City, IN 47660
Country
Country
USA
USA
Email Address Telephone Number
Email Address
Telepho a Nu b r
pursuant to IC 6-1.1-12- 4, the Sales Disclosure Form maybe used to Apply forcertain deductions..ldentify all of those th t pp o
CV
YES NO CONDITION YES NO CONDITION N
0 ❑ 1. Will this property be the buyer's primary 0 ❑ 3. Homestead 1 N
residence? [:I 0 .,�
4. Solar Energy Heating or Cooliroem Q
❑ ❑ 2. Does the buyer have a homestead to be vacated ❑ 0 5. Wind Power Device :z
for this residence? If yes, provide address: ❑ 0 6. Hydroelectric Power Device
Address (number and street) ❑ ❑r 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County
00D.759-Do'1
Underpenalties of perjury, I hereby certify that this Sales Disclosure;.to the best of my knowledge.and belief; istrue,.correct, and complete
as required by laws. and is prepared in accordance withJC 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of
transferred eatWoperty,,or omits or falsifies any information required to be provided,:commits.a Level 5 felony. (Noter,Both. spouse's
`lnfor ti ,' SSN rlver's Licens 1ID/Other Number is necessary only if a Homestead Deduction is being filed.)
SignAur6 f Buy 1 � �
Sign ture of BuXa—rjJSpouse
Printe Legal Name of Buyer 1 Sign Date (MM/DCWY)
Printed L g I Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Donald K. Wilder
Mary An6lmllder
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
0 7
- �6�7
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