HomeMy WebLinkAboutHomestead_NeberH. PREPARER
Preparer of the Sales Disclosure Form
Title
Sandra L. Hicks
Attorney
Company
Email Address
Telephone Number
Sandra L. Hicks Law Office, LLC
sandrahickslaw2@gmaii.com
(812 ) 615-5044
ress (number and street. city, state, country, and ZIP Code)
L843S. 9th Avenue, Haubstadt, IN 47639
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Colton R. Bajzath
Melissa Marie Bajzath f/k/a Melissa Marie Gonzales
Address (number and street)
Address (number and street)
7011 N. Nixon Road
7011 N. Nixon Road
City, State, and ZIP Code
City, State, and ZIP Code
Hazleton, IN 47640
Hazleton, IN 47640
Country
Country
Gibson County - USA
Gibson County - USA
Email Address
Telephone Number
Email Address
Telephone Number
2 )
Under penalties of 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 ature of Selle
Signature•of Seller
-
Printed Name of Seller
Date Signed (mmlddlyyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Colton R. Bajzath
3B Q
Melissa Marie Bajzath
--//
J. BUYER(S)IGRANTEE(S) — APPLICATION FO PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appears on v an a do c me t
Jacob Neber
Address (number and street)
Address (number and street)
307 S. Main Street
City, State, and ZIP Code
City, State, and ZIP Code SEP 3 0 2026
Patoka, Indiana 47666
Country
Country
Gibson County - USA
Email Address
Telephone Number
Email Address GlBSO N COU
ber
(eZV- )C42-7 - (qS
ALIC�ylTO)3
Pursuant to IC 6-1.1;4244, the Sales Disclosure Form may be used to apply for.certain deductions. identify all of those that apply:
YES NO CONDITION YES NO CONDITION
Will this property be the buyer's primary 0 ❑ 3. Homestead
❑ El
residence?
residence? ❑ 0 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated ❑ 5. Wind Power Device
for this residence? If yes, provide address: ❑ 0 6. Hydroelectric Power Device
Address (number and street) ❑ El 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County _ i oa,o��
Under penalties of perjury,) 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-S.S. 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/1D/0ther Number is necessary only if a Homestead Deduction is being riled.)
Signat Buyer 1
Signature of Buyer 2/Spouse
0-Z
rinted Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Jacob Neber
Last 5 of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
1Digits
I
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