HomeMy WebLinkAboutHomestead_KozarH. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
E-mail Address
Telephone Number
True Title Service, LLC
jamie@truetitlein.com
(812) 453-2559
Address (numberand street, city, state, country, and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears oAonvlale m
lj
Southern Indiana Home Investments LLC
Address (number and street)
Address (number and street)
JUL
2416 Shannon Street
17
City, State, and ZIP Code
City, State, and ZIP Code
Washington, IN 47501
Country
Country
GIBSON COO j
E-mail Addr ss
e e hone.Nu r
E-mail Address
Telepho umber
Under naltie of pe ury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as
requir d by la , and prepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of transferred
real operty s or falsifies any information required to be provided, commits a Level 5 felony.
Sig turme!e'lCr
Signature of Seller
me
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Anithony Lengacher, Member
July 9, 2026
July 9, 2026
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
Paula Dean Kozar
Address (number and street)
Address (number and street)
321 East Oak Street
City, State, and ZIP Code
City. State, and ZIP Code
Oakland City, IN 47660
Country
Country
E-mail Address Telephone Number
E-mail Address
Telephone Number
pdkozar@gmail.com
(812) 403-1372
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
IrQ❑ 3. Homestead
1. Will this property be the buyer's primary
❑
residence?
❑ 4. Solar Energy Heating or Cooling System
❑ 5. Wind Power Device
Vf2. Does the buyer have a homestead to be vacated
or this residence? If yes, provide address:
❑ Er— 6. Hydroelectric Power Device
❑ 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, ZIP code, and Count
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 only N a Homestead Deduction is being filed.)
Staturepf BLIN 1 067
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Signature of Buyer 2/Spouse
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Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Paula Dean Kozar July 9, 2026
July 9, 2026
Last 5 Digits of Buyer 1SiwDJiver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/other Number
S 5 L�
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