HomeMy WebLinkAboutHomestead_CulverH. PREPARER
Preparer of the Sales Disclosure Form
Title
Sandra L. Hicks
Attorney
Company
Email Address
Telephone Number
Sandra L. Hicks Law Office, LLC
sandrahickslaw2@gmail.com
( 812 ) 615-5044
Address (number and street, city, state, country, and ZIP Code)
843 S. 9th Avenue, Haubstadt, Indiana 47639
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears Ac n f4ce do nt
William A. Folsom, Jr., Trustee of the William A. Folsom, Jr. Revocable Living Trust dated 718122
Address (number and street)
Address (number and street)
4195 S 700 W
City, State, and ZIP Code
City, State, and ZIP Code
Owensville, IN 47665
Country
Country
0IBSON
USA - Gibson County, IN
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Email Address
Telephone Number
Email Address �/n.
ephone Number
(g!2-
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Under penalties of perjury, 1 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 6-1.1-5.5. 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,
Signature
of Seiler
Signature of Seller
Printed Name of Seller
Date Signed (m lddlyyyy)
Printed Name of Seller
Date Signed (mm/ddlyyyy)
William A. Folsom, Jr., Trustee
J. BUYER(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
Ronald Culver
Address (number and street)
Address (number and street)
104 E.Poplar Street
City, State, and ZIP Code
City, State, and ZIP Code
Owensville, IN 47765
Country
Country
USA - Gibson County
Email Address
Telephone Number
Email Address
Telephone Number
( � I &) j 2Z -O 0�
I ( )
I. Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to appty 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 ❑
0 3. Homestead
residence?
❑ [a 4. Solar Energy Heating or Cooling System
❑ ❑ 5. Wind Power Device
❑ ❑ 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ El 6. Hydroelectric Power Device
❑ [E] 7. Geothermal Energy Heating or Cooling Device
i�� - ��� �' _ 1-1OL-1- COZ), S9(D _ 03a
Address (number and street)
City, State, and ZIP Code County
Under penalties of perjury, 1 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 spouses
information, SSN/Driver's License/ID/Other Number is necessary only if a Homestead Deduction is being filed.)
Sigg �of 1
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date (MM/DDNY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Ronald Culver
Last 5 Digits of Bu er 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2JSpouse SSN/Drivers License/ID/Other Number
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