HomeMy WebLinkAboutHomestead_ButtrumH. PREPARER
Preparer of the Sales Disclosure Form
Title
LaToya Woodruff
Closing Agent
Company
E-mail Address
Telephone Number
Columbia Title, Inc
ioodruff@columbiatitlegroup.co
(812) 471-8563
Address (number and street, city, state, country, and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
1. SELLER(S)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Gary T. McCarty
Address (num, er and street)
Address (number and street)
City, State, and ZIP Code
City, State, and ZIP Cade
Count
Country
E-mail Address
Tel phone Number
E-mail Address
Telephone Number
Under penalties 6f 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 prope , or omits or falsifies any information required to be provided, commits a Level 5 felony.
Signatu ell /��
Signature of Seller
Pri ted N e of Seller
Date tBn _d,(m/ddtyyyy)
Printed Name of Seller
Date Signed (rnm/dd/yyyy)
Gary T. McCarty by Terry R. McCarty, Atte
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIF LL IWAPLLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it appears on conveyan cume
Roger Buttrum
Address (number and street)
Address (number and street) FP'�?'OU
1%�vr_t
0
C State, and ZIP Code
City, State, and ZIP Code < UeF
n = JM, //V"—/M
Country n
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Country O�
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E-mail Address
Telephone Number
E-mail Address
—_ umber
buttrumra@hotmail.com
812 201-0754
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Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply forcertaindeductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
Q; ❑ 3. Homestead
1. Will this property be the buyer's primary
P❑ residence?
❑ 4. Solar Energy Heating or Cooling System
❑ 5. Wind Power Device
�/2. Does the buyer have a homestead to be vacated
xI.
for this residence? if yes, provide address:
❑ MA 6. Hydroelectric Power Device
❑ Q' 7. Geothermal Energy Heating or Cooling Device
� � � � ry w —Le—AC)� . �C
Address (number and street)
City, State, ZIP code, and 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 only if a Homestead Deduction is being filed.)
Si lure of u r 1
Signature of Buyer 2/Spouse
s
Print d LegarName of Buyer 1 Sign Date ( /DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Roger Buttrum C)Q , wral tg,&j
(Last 5 Digits of Buyer SS N/Driver's License/ID/Other Number
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Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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