HomeMy WebLinkAboutHomestead_Johnson (3)H.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, IN 47639
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Rhonda Sumner
Address (number and street)
Address (number and street)
511 S Stormont Street
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, Indiana 47670
Country
Country
Gibson County - USA
Email Address
Telephone/
Email Address
Telephone Number
-Number
Under penalties of perjury, 1 hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete as
requirep 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 pr9perty, or omits r falsifies any information required to be provided, commits a Level 5 felony.
Si. n re of Seiler
w41
Signature of Seller
Prin ed Name of Seller U
Dqigge )
Printed Name of Seller
Date Signed (mm/ddlyyyy)
Rhonda Sumner
L 1 XX
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
Gunner Johnson
Address (number and street)
Address (number and street)
511 S Stormont Street
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Country
Country
Gibson County - USA
Email Address
Telephone Number
Email Address
Telephone Number
xi L)
Pursuant to IC 6-1.1-12- 4, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
❑ ❑ 1. Will this property be the buyer's primary
El❑ 3. Homestead
residence?
❑ 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:
❑ ❑ 6. Hydroelectric Power Device
❑ Q 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, and ZIP Code County
Under penaities.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 nature of B er 1 (}
Signature of Buyer 2/Spouse
Printed Legal N me of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 21Spouse Sign Date (MM/DD/YY)
Gunner Johnson
Last 5 Digits of Buyer 1 SSN!Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's Lice nseilD/Other Number
Page 3