Closing Documents Larry/Shirley Gollmer - Shelborne at 116thCLOSING STATEMENT
Section 6045 of the Internal Revenue Code, as amended by the Tax Reform Act of 1986, requires
the reporting of certain information on every real estate transaction. The information provided
below, except for the tax identification number, is adequate information to provide to a tax
professional.
FEE OWNER: Larry P. Gollmer and Shirley Padgett Gollmer
ADDRESS: 11615 Shelborne Road
DESCRIPTION OF PROPERTY: A part West Half of the Southwest Quarter of Section 32,
Township 18 North, Range 3 East, Hamilton County, Indiana
PROJECT: 05-06 (116th & Shelborne Roundabout)
PARCEL: 2 COUNTY: Hamilton
CLOSING DATE: PURCHASE PRICE: $ 10,500.00
LAND AND/OR ADMINISTRATIVE SETTLEMENT: $ 0.00
IMPROVEMENTS: $7,600.00 DAMAGES: $ 2,500.00
I (we) certify that the above is true and correct and acknowledge receipt of payment.
Fee Owners 2 — o 7
ignature Date
e
Signature
• .., , •
Date
3417 Sherman Drive o Beech Grove, Indiana 46107 ■ Tel 317.780.1555 ■ Fax 317.780.5525
; ‘; , ,302/14)07
PADGETT GOLLMER FOR PAYMENT OF
CARMEL COIT 2006 CF CONSTRUCTION PARCEL #2 ;PAYMENT REQUEST •
ACCOUNT NUMBER : 81-9528-06-8
1;11 I IA PP ****$10.500.00
PAY [STEN THOUSAND FIVE HUNDRED DOLLARS AND ZERO CENTS **** ******
TO THE LARRY P GOLLMER AND
ORDER SHIRLEY PADGETT GOLLMER
OF
CHECK VOID AFTER 6 MONTHS
REGIONS BANK
BIRMINGHAM, AL
"S&29980" 1:062005690i: 03 0077 234811•