HomeMy WebLinkAboutHomestead_HollanderH. PREPARER
Preparer of the Sales Disclosure Form Title
Kelly E Norton i Settlement Apent
Email Address Telephone Number
Company
( 812 ) 421-4000
Bosse Title Company
Address (number and street, city, state, country, and ZIP Code)
4799 Rosebud Lane, Newburgh, IN 47630
I. SELLERS)/GRANTOR(S) _
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Henry R. Hollander
Teelia J. Pancake
Address (number and street)
Address (number and street)
7682 S. 650 E.
7682 S. 650 E.
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648
Fort Branch, IN 47648
Country
Country
us
US
Email Address Number Email Address Telephone Numberhenryrhollander@gm7---I—Telephone
( 812 ) 664-8182 01A ,)
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete as
IC 6-1.1-5.5. A who knowingly and intentionally falsifies the value of transferred
required by law, and is prepared in accordance with person
real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. —
Signa ure of Seller Signature of Seller T
Printed N�JR_e ller Date Signed (mmlddlyyyy) Printed Name of Seller Date Signed (mmldd/yyyy)
it
Henry R. Hollander 09/17/2026 i Teelia J. Pancake — 09/17/2026
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 vej aTc c
l
Ba_ylee. I-i of lander_.,.. -E 1
Address (number and street) Address (number and street)
17682 S. 650 E.
R City, State, and ZIP Code I
City, State, and ZIP Code SEP 2 5 2026
Oakland City, IN 47660
I.
Country
Country
uS
Email Address
Telephone Number
Email Address
GIBBON C
e r
I�NTY A�IDITOR
( 812 ) 664-8010
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
1. Will this property be the buyer's primary
® O 3. Homestead
® residence?
0 ® 4. Solar Energy Heating or Cooling System
O ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
of
j°°
O �� for this residence? If yes, provide address:
p ® 6. Hydroelectric Power Device
Q ® 7. Geothermal Energy Heating or Cooling Device
and street)
C) _ �CJQ' • 3E5 ^acalties
and ZIP Code County
rumber
of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete
d by law, and is prepared in accordance with IC 6-1.1-6.5. A person who knowingly and intentionally falsifies the value of
real property, or omits or falsifies any Information required to be provided, commits a Level 5 felony. (Note: Both spouse's
n, SSN/Driver's License/ID/Other Number is necessary only if a Homestead Deduction is being fled.)
Signature of Buyer 1
Signature of Buyer 2/Spouse
j
_,.
Prin�Legame of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DDNY)
Bayr 9/17/2026
09/17/2026
--- -
Last 5 Digits o uyer 1 SSN( ri er s LicensellD/ ther Number
Last 5 Digits of Buyer 2/Spouse SSN/Drivers License/ID/Other Number
Page 3