HomeMy WebLinkAboutHomestead_Rogier H. PREPARER
Preparer of the Sales Disclosure Form 'Title
Lana Harper Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
5231 Oak Grove Road.Evansville,IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document
Jennifer C.Simms Seller 2-Name as appears on conveyance document
Address(number and street)
4711 Capehart St Address(number and street)
City,state,and ZIP Code
Evansville,IN 47725 City,state,and ZIP Code
Country Country
United States of America United States of America
knowingly and intentionally falsifies the value of transferred
real props ,or omi or fal ny Information required to be provided,commits a Level 5 felony.
`gnatur 1 signature of Seller
dMed ame of S r 1 Date m ) Printed Name of Seller Date signed(mm/dd/yyyy)
Jenn r C.Simms i / ` �
J.BUYER(S)/GRANTEE(S)—APPLICATION F R PROPERTY TAX DEDUCTIONS-=IDENTIFY ALL THAT APPLY
Buyer 1-Name as It appears on conveyance document
Buyer 2-Name as appears on conveyance document
Marty L.Rogier
Address(number and street) Address(number and street)
521 S.Eighth Ave
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt,IN 47639
Country Country
United States of America
deductions.Identify all of those that apply:0
YES NO CONDITION J YES NO CONDITION O°ia
Er ❑ 3. Homestead ztrj
I1 0 1.Will this property be the buyer's primary residence? c�r 0
C
0 ® 4.Solar Energy Heating or Cooling Sy m H
cm
❑ 2Eff .Does the buyer have a homestead to be vacated for 0 l 1 5.Wind Power Device z ry
this residence?If yes,provide address: ❑ 1 6. Hydroelectric Power Device y.• t
Address(number and street) 0 B 7.Geothermal Energy Heating or Cool,.. ice d
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City,state,and ZIP Code County XI
26-23-06-200-000.791-009
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