HomeMy WebLinkAboutHomestead_Loomis H. PREPARER
Preparer of the Sales Disclosure Form Title �
Shannon Valiant "'`c--' -D i C __.
Address(number and street,city,state,country,and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
i I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
Channon DeFawn Martin
Address(number and street) Address(number and street)
'3O R.04.k. Rd
City,State and ZIP Code City, State and ZIP Code
, IN O\nveti .j tLe •�'h.I 41 t Le '
Country Country
United States of America ArpkG i 1-3.Cn VI Telephone number
Under penalties of pert dry, 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
valu of ansferred real property,or omits or falsifies any information required to be provided, commits a Level 5 felony.
Si a re f Seller 4,(2u1211 ::::::::eller
(mm/dd/ned
Printe Name of Seller1 Date signed(mm/dd/yyyy) Date signed yYYY
Channon DeFawn Martin
12/20/2021 12/20/2021
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
Casey Loomis
Address(number and street) Address(number and street)
IDOS 6 . (43.-AMt-A\ TV "T"-
City, State and ZIP Code City, State and ZIP Code
, IN OV E-.�SVAl LC-. , t.,] `",1')(P
Country Country
United States of America hone number
E-mail address
apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION N
RI 0 1. Will this property be the buyer's primary residence? 0 0 3. Homestead o
0 l 4. Solar Energy Heating or Cooling o
❑ c' 2. Does the buyer have a homestead to be vacated for ❑ E1 5, Wind Power Device ys __
this residence? If yes, provide address: 0 El 6. Hydroelectric Power Device a i-
Address(number and street) 0 El 7. Geothermal Energy Heating or Cpp,14 Dever
stil
u_i �c.a
City,State,and ZIP Code County w o
VP-j 7./2- /•Ota z2.4-6)2. .- cn
co
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct act o
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 if a Homestead Deduction is being filed.)