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HomeMy WebLinkAboutHomestead_DyehouseH.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 I. SELLERS)/GRANTOR(S) Seller 1 — Name as it appears on conveyance document Seller 2 — Name as appears on conv&xance document Brenda Witt as POA for Evelyn Mounts Address (number and street) Address (number and street) 1753 Outer Lake Road City, State, and ZIP Code City, State, and ZIP Code Princeton, IN 47670 J07 Country Country 2026 USA Email Address Telephone Number Email Address (�/B Telephone Number bfmw1974@gmail.com (812 ) 550-7168 SON . ) Under penalties of perjury, 1 hereby certify this Sales Disclosure, to the best of my knowledge and belief,.is: t� n complete as required by law, and is prepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentionally falsifie3 a of transferred real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. Sig ture of Seller iz:;: Signature of Seller Printed Name of Seller Date igned (mmidd/yyyy) Printed Name of Seller Date Signed (mm/dd/yyyy) Daniel A. Moon 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 on conveyance document Chase Dyehouse Address (number and street) Address (number and street) 2110 W 450 N City, State, and ZIP Code City, State, and ZIP Code Patoka, IN 47666 Country Country USA Email Address Telephone Number Email Address Telephone Number Pursuant to IC 6-1.1-12-04 the Sales Disclosure Form may be used to apply for certain deductions. Identify all of thoseithat apply: YES NO CONDITION YES NO CONDITION 1. Will this property be the buyer's primary ❑ El ❑ 3. Homestead residence? ❑ 0 4. Solar Energy Heating or Cooling System ❑ [Z] 5. Wind Power Device 2. Does the buyer have a homestead to be vacated ❑ for this residence? If yes, provide address: ❑ 0 6, Hydroelectric Power Device ❑ 0 7. Geothermal Energy Heating or Cooling Device Address (number and street) !�� 01-I — } 1� , t QC —030 , io 3l — © LFS 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 Li enseAD/Other Number Is necessary only if a. Homestead Deduction is being filed.) Signature of Buyer 1 P ISignature of Buyer 21Spouse Printed Legal Name of Buyer 1 Sign Date (MM/DDNY) Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY) Chase Dyehouse —/Z10Z6 Last 5 Digits of Buyer 1 SSNIDriver s License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number 13 "7 Page 3