HomeMy WebLinkAboutHomestead_Simpson (2)H. PREPARER
Preparer of the Sales Disclosure Form
Title
Taylor M. Millsap
Attorney
Company
Email Address
Telephone Number
Team Black Law, P.C.
tmillsap@teamblacklaw.com
(812 ) 407-4311
Address (number and street, city, state, country, and ZIP Code)
302 E. Main Street, Francisco, Indiana, USA, 47649
I. SELLERS)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Stacy Simpson, now known as Stacy Patmore
Address (number and street)
Address (number and street)
613 East 4th Street
City, State, and ZIP Code
City, State, and ZIP Code
Huntingburg, Indiana 47542
Country
Country
USA
Email Address
Telephone Number
Email Address
1
Telephone Number
(812 ) 827-1493
( )
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 A person who knowingly and Intentionally falsifies the value of transferred
real grope . .or omits or falsifies any information required to be provided, commits a Level 5 felony.
Signatur I or
Signature of Seller
Printed Name of SelIeV
Date Signed (mm/dd/yyyy)
Printed Name of Sailer
Date Signed (mrrVddlyyyy)
Stacy Patmore
110/16/2026
J. BUYER(S)IGRANTEE(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 a went
Damian SimpsonTN
Address (number and street)
Address (number and street)
108 North Center Street
City, State, and ZIP Code
City, State, and ZIP Code
OCT1
Francisco, Indiana 47649
Country
Country
USA
Email Address
Telephone Number
Email Address
Tel phone Number
simpsondamian32@gmail.com
(812 ) 6774699
fr_
Pursuant to IC 6-1.1-1244, the Sales Disclosure Form may be used to apply for certain deductions. Identify al ofih6W10W iRply:
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
O O 3. Homestead
® O residence?
O O 4. Solar Energy Heating or Cooling System
O O 5. Wind Power Device
2, Does the buyer have a homestead to be vacated
O O for this residence? If yes, provide address:
O (D 6. Hydroelectric Power Device
O p 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
_' �'a� _ , �' _000 , 'Jl \ —ODE
City, State, and ZIP Code County
Under penalties of perjury, I hereby certify that this Sales Disclosure, to thebest of my knowledge and belief,.Is. true, ,correct,,and complete
as required by law, and is prepared in accordance with IC 6-1.1.B.S. A person who knowingly and intentionally falsifies the value of
transferred real property, or o s r falsifies any information required to be. provided, commits a Level 6 felony. (Note: Both spouse's
Info SN/Drlver's LlognselID10therNumberis necessary only If a Homestead Deduction is being. filed.). ..
Sindatur of 8 r 1
Signature of Buyer 21Spouse
1
Printed egal me of Buye 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Dale (MM/DD/YY)
Damian Simpson 10116/2026
Last 5 Digits of Buyer 1 SSN/Driver's Licenso/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN10river's LlcensellD/Other Number
SSN; 21545
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