HomeMy WebLinkAboutHomestead_Moore (3)H.PREPARER
Preparer of the Sales Disclosure Form
Title
Abbey Moore
Closing Agent
Company
E-mail Address
Telephone Number
Columbia Title, Inc
abbey@columbiatitlegroup.com
(812) 471-8563 ext. 400
Address (number and street, city, state, country, and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLER(s)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on n o t
Martha J. Krohn
Address (number and street)
Address (number and street) JIL
P.O. Box 127
City, State, and ZIP Code
City, State, and ZIP Code
OCT
Holland, IN 47541
2 ]
E-Cquniry
Country
E-mail Address
Telephone Number
E-mail Address
o e Number
Krohnmj@gmail.com
(812) 664-3467
GIBBON CON
Inip,
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct hhyEbmplete 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 azure of Seller
Signature of Seller
Printed Name of Seller V
Date igned ( Wd )
Printed Name of Seller
Date Signed (mmltldlyyyy)
Martha J. Krohn
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
Beth L. Moore
Patricia Jo Bathgate
Address (number and street)
Address (number and street)
601 South Seminary Street
520 West Emerson Street
City, State, and ZIP Code
City, State, and ZIP Code
PCrriiunrccettton, IN 47670
Princeton, IN 47670
V %
MN
E-mail Address
Telephone Number
E-mail Address
elephone Number
b.auberry@aol.com
812 664-3748
b.auberry@aol.com
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
Y�E,S( NO CONDITION
�C ❑ 3. Homestead
p� ❑ 1. Will this properly be the buyer's primary
-�I residence?
❑ Ig 4. Solar Energy Heating or Cooling System
❑ [N 5. Wind Power Device
❑ EZ 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ ® 6. Hydroelectric Power Device
❑ ® 7, Geothermal Energy Heating or Cooling Device
Address (number and street)
r")/ _ , Il - 0-7_ 102) —00\ 51(P _ C45tg
City, Slate, ZIP code, and County
Under penalties 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 Homestead Deduction is being Filed)
Signature of Buyer 1
1 nature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Si
pNDD/YV)
Printed Legal Name of yer 2/Spouse Sign ate (y1MIDD/yy)
Beth L. Moore o I
����,,��tfj
Patricia Jo Bathgate lP �96
s 5 Digits of Bu er 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Drivers License/ID/Other Number
p
s 5
Page 3
H. PREPARER
Preparer of the Sales Disclosure Form
Title
Abbey Moore
Closing Agent
Company
E-mail Address
Telephone Number
Columbia Title, Inc
abbey@columbiatitlegroup.com
(812) 471-8563 ext. 400
Address (number and street, city, state, country, and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Martha J. Krohn
Address (number and street)
Address (number and street)
P.O. Box 127
City, State, and ZIP Code
City, State, and ZIP Code
Holland, IN 47541
Country
Country
E-mail Address
Telephone Number
E-mail Address
Telephone Number
Krohnmj@gmail.com
(812) 664-3467
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.
Signature of Seller
Signature of Seller
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Martha J. Krohn
Q a (Q
(812) 677-0418
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
Bruce J. Moore
Address (number and street)
Address (number and street)
1811 South Main Street
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
tgt�y
Country
-mail Address
Telephone Number
E-mail Address
Telephone Number
bmoore8623@gmail.com
W9L &77 - IS
I b.auberry@aol.com
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
❑ 3. Homestead
1. Will this property be the buyer's primary
❑
residence?
❑ 4. Solar Energy Heating or Cooling System
❑ ® 5. Wind Power Device
jqA 2. Does the buyer have a homestead to be vacated
❑ for this residence? If address:
V! yes, provide
❑ ® 6. Hydroelectric Power Device
❑ 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, Stale, ZIP code, and County
Under penalties 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, SSNIDriver's License/ID/Other Number is necessary only if a Homestead Deduction is being filed.)
Si atur of Buyer 1
Signature of Buyer 2/Spouse
Printed Le me of Buyer 1 Sign
Date (MMIDDIYY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MMIDDIYY)
Bruce J. Moore 101
QG I 9.0ma
Last Oigits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
2- -3
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