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HomeMy WebLinkAboutHomestead_BarneyH..PREPARER - - Title 1 Preparer of the Sa s Disclosure Form z - Company EmailTeleph Address one Number jj/I Address (number an street, city state, countrv, anJ.7,IP Code) I. SELLER(S)/GRANTOR(S) Sell ame as it appears on conveyance document Seller 2 - Name as appears on conveyance document &�V`l U",P,\ Address (number and street) Address (number and street) -a_6si� ct p — ---V - D-- - -- -' City, State, and ZIP Co�djej �j I j Ylcr+V^ �L" ( L 16?G% City, State, and ZIP Code p J --- Country -------�i-f 7 -- - Country - Email Address Jdujv1� Gntrvc . Gcrr� Telephone Number (���) %�Y Email Address Telepryone Number 49 �f,�. Ac 1 Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is rue, eQi/®hl!onmplete as required by law, and is prepared in accordance with 1C 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 ture of S 'pr I Signature of Seller Printed Name ®off Sealer Date Signed (mmldd/yyyy) Printed Name of Seller Date Signed (mmlddlyyyy) 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 ap earsonconveyance document i Gt l C Y mete Gn W- �r - — Address (number and street Address (number and street} City. State, and ZIP Code _ M Cat r ( L 7°� City, State, and ZIP Code /11�� Lit �� m�l�- vnT Country I Country Email Address Telephone Number Email Address Telephone Number 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 y 3. Homestead 1. Will this property be the buyer's primary O residence? p ❑ 4. Solar Energy Heating or Cooling System !J O 5. Wind Power Device 0 pj­ 2. Does the buyer have a homestead to be vacated for this residence? If yes, provide address: D D 6. Hydroelectric Power Device Q ❑ 7. Geothermal Energy Heating or Cooling Device - Address (number and street) i City, Slate. and ZIP Cade C 1:y U5-a�) - UO&I I Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete I as required by iaw,.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/©river's License!!D/Other Number is necessary only if a Homestead Deduction is, being filed.) ---- - — I Sig afore of Buyer 1 a_c Signature of Buyer 2: Sr _;se Phi e . Legal Name of Bak 1 Sign Date (i_ m Jb D—C,(Y)) Printed Leaal Nan-e of Buyer 2/Spouse Sign Dare (MM/DD Y`O 3_26 g2.99 E d Digits of Buyer 1 SSN,rDri,ver s L censerlD!Qther Nun?ber Last 5 Digits ofBuyer 2iSpouse SSN/Driver's License!IDiOther NurrL r itLast Page 3