HomeMy WebLinkAboutHomestead_HarpenauH. PREPARER:
Preparer of the.Sales Disclosure Form
Title
Ami a Gass
Settlement A ent
Company
Email Address
Telephone Number
Hgmetown Ti
orders@h metowntitles.com
( 812 ) 461-6399
Address (number and street, city, state, country, and ZIP Code)
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
I. SELLER(S)IGRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Stephen L. Kohlmeyer
Brenda L. Kohlmeyer
Address (number and street)
Address (numberand street)
1116 N Main St
1116 N Main St
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
US
us
E,,t n Address- {
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Telephone Number _
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Email Address
Telephone Number
( `y )
a I ,S3'�ii 1 d •.4. :�
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Under penattleswof 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 6-1,1-5.5. 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.
Sig of Seller :t —..
Signa�rre of $�Iler f
y
Printed Name of Seller
Date Signed (mm/dd/yyyy)
ed Na of ellef j
Date Signed (mm/dd/yyyy)
Stephen L. Kohlmeyer'
' -
Brenda L. Kohlmeyer i
J. BU.YER(S)IGRANTEE(S) - APPLICATION FOR. PROPERTY TAX DEDUCTIONS — IDENTIFY ALL'TIHAT APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it appears on document
Marvin Ha au
G
Address. (jrumber and street) s'
Address (number and street)
SO
City, State, ZIP Code ; q
City, State, and ZIP Code
JUL �4
Country
Country
us
Email Address
Telephone Number
Email Address G113 Q
hQnaJNumber
Pursuant to IC 6-1.1-12-44,.the :Sales Disclosure Form may be used to apply for certain deductions. Ideniifyail of those h ppiy:.
YES NO CONDITION
YES NO CONDITION
® ❑ 1. Will this property be the buyer's primary
I9 0 3. Homestead
residence?
0 M 4. Solar Energy Heating or Cooling System
0 ® 5. Wind Power Device
0 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
0 ® 6. Hydroelectric Power Device
0 0 7. Geothermal Energy Heating or Cooling Device
O�p _ 30tq_ 001
Address (number and street)
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 bylaw, and is prepared in accordance with IC 6-1A-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, SSMDrlver's UcensellDlOUrerNumber Is necessary only If a Homestead Deduction Is being filed)
S'sgra�tyre of Buyer
Signature of Buyer 2/Spouse
Printed. Legal_Name'of Bt#er 1 Sign Date (M IDD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Marvin Harpenau
Last 5 Digits of Buyer 1 SS.N/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/lD/Other Number
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