HomeMy WebLinkAboutHomestead_HillsH. PREPARER
Preparer of the Sales Disclosure Form
Title
Christa D. Tracey
Escrow Officer
Company E-mail address Telephone number
'Southwestern Indiana Land Title christa@swihiand.com 1(812)
425-0055
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as it appears on conveyance document
Robert C. Kime
Vanessa L. Kime
Address (number and street)
Address (number and street)
402 N Gibson St.
402 N Gibson St.
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
United States of America
United States of America
Email Address
Telephone Number
"AW
Email Address
Telephone Number
gko4 % �'-S
1
12(()0 5-Vk qiv -\4
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 6-1.1-6.6. 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.
Signature f C
Si n fu�i a of Seller
Printed Na a of Seller
Date Signed (mm/dd/
Pri ted Name of Seller
Robert C. Kime
yyyy)
Vanessa L. Kime,
rDate�n;e�d(mdd/yyyy)
/
J. BUYER(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-ri an , ent
Kimberly J. Hills
Blaine A. Dye
Address (number and street)
Address (number.and street)
220 N Main St
220 N Main St
City, State and ZIP Code
City, State and ZIP Code APR 1 �QZ�
Oakland City, IN 47660
Oakland City, IN 47660
Country
Country
United States of America
United States ofAmeric
Email Address
Telephone Number
Email Address COUNT-)W)7
Number
KJoHills@gmail.com
(812) 890-0093
Wak_20@hotmail.com
(80727
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
LI ❑ Will thisproperty be the buyer's primary residence?
0 ❑ 3. Homestead
❑ 0 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide address:
❑ 0 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
Address (number and street)
❑ 0 7. Geothermal Energy Heating or Cooling Device
®
- - tO �`
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 information, SSN/Driver's
License/ID/Other Number is necessary if a Homestead Deduction is being Hledf
Si ature of Buyer 1
Si re of Buyer 2/S use
Printed Leg ame of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Kimberly J. Hills tl-0Qa21110
Blaine A. Dye L"Q-Ll,
Last 5 Digits of Buyer 1 SSN/Driver' License/ID/Other Number
SSN: �
Last 5 Digits of Buyer 2/Spouse SSN/Drive�r''s,pLicense/ID/Othe Number
SSN: C14+-`
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