HomeMy WebLinkAboutHomestead_HagenH. PREPARER
Preparer of the Sales Disclosure Form
Title
Brian K. Mahoney
Attorney
Company
Mahoney Law Office
Email Address Telephone Number
brian@nahoneylawin.com (812 ) 354-8121
Address (number and street, city, state, country, and ZIP Code)
822 E Main Street Petersburg, IN 47567
i
I. SELLER(5)IGRANTOR($)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Debra L. Cain aka Debra Cain
Address (number and street)
Address (number and street)
6643 E 450 N
City, State, and ZIP Code
City, State, and ZIP Code
Francisco, IN 47649
Country
Country j1 Ui/V
United States
Email Address
(elgp/ on)e Num�r ��b
Email Address
one Number
t7nderpenaltiesofperjury,. 1-herebycerti this Sales.Disclos.ure,to the best_of.my knowled e c( rect, and complete as.
fY'
6-1:1-5:5::A-person who knowingly and Inten a�1y value of transferred
required �'•by�law,.,and`Is prepared=in. accorclancedwlftIC
real :r orr►lts or,falsifies any,i_nfonna'tion, egwred to be prov(_ded,,commits a,Level 5:felony. / A
.petty," jp
Si atu a of Iler Signaturelof Seller R
IP r d of a let
Date Signed (mmldd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Debra L. Cain Debra Cain
aka
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J. B,UYER(S)YGRANTEE.('3) - APPL'-:ICAITION FOR PROPERTY TAX' tDUCTIONS -,IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appears on conveyance document
Aaron L. Hagen
Sabrina L. Hagen
Address (number and street)
$-
Address (number and street)
2 S. i�JS� St
P
i , State, and ZIP Code
C7 (o
C , State, and ZIP Code
fuC"Ilof f f /A) 47V V Q
tK i
Country
United States
Country
United States
Email Address
Telephone Number
(5+a )�3�-��55
Email Address
� 11S-�f�GGrj1Gr� GL�'L
�elephoneNumberht
PursuanCto LC . ,1:1 12-4'4; the Sales Disclosure .Formsmay=be usedAo,gppjy for,certain deductions..Identify.ail-of'thoseahat.aPply:
YES NO CONDITION
Y NO CONDITION
1. Will this property be the buyer's primary
O 3. Homestead
O residence?
O O 4. Solar Energy Heating or Cooling System
O 25. Wind Power Device
d 2. Does the buyer have a homestead to be vacated
O for this residence? If yes, provide address:
O Q 6. Hydroelectric Power Device
O O 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
_ �q o- ozD - 0m, 0e`5
City, State, and ZIP Code County
Under=penalties.of?perjury ,I thereby cerfifp�that tl is SalesmEiisclosure, to•the bestof<mynknowledge>and:belief, "s true,;correct,,and complete
IC 6-1A_46: A person who knowinglyand,lntentionally falsif�es.the.value of
as,required,bylaw; and�is p,reparediln<accordancewith
transferred•real,property;,or omits,.or•faisifies<<any Information_requIredlt&be provided�;commits,a'Level &felony. (Note::Bofh=spous_.e's
. f a:Nomestead Ded cdon:is-bei0g;fileol:)
information, SSN/Dn4, is Licensevib other-Numberis:necessaryoni
ure, of B�ofuyer
SId
Signature of Buyer 1
Printed Legal Name of Buyer 1 Sign Date (MMlDDlYY)
Pti Legal/Spouse Signyate(M�/DD/YY)
1
Aaron L. Hagen
Sabrina IL. Hagen t�
Last 5 Digits of Buyer 1 SSN/Driver's Licens ID/Other Number ,�, , _
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
2<<,_ 55
�ss iarc�Vl1-�
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