Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Homestead_Smith (28)
H. PREPARER ' Preparer, ^o.f the Sales Disclos�lre Form Title La.0 c-- Ale ` Title Company Company Lt/� Regional Title Services LLC . . Address(number and street,city,state,country,and ZIP Code) 7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715 I. SELLERS)/GRANTOR(S) Seller 1-Name as It appears on conveyance document Seller 2-Name as appears on conveyance document Shawn Dewayne Fortner Address(number and street) Address(number and street) 6816 W.Base Road City,state,and ZIP Code City,state,and ZIP Code Princeton,IN 47670 Country Country US 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 Sic/Nature of Seller ,,��,,�p "'� `�v "" � Printed Name of Seller Dote signed(mm/ddlyyyy) Printed Name of Seiler Date signed(mmldd/yyyy) Shawn Dewayne Fortner 01/07/2022 01/07/2022 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 on conveyance document Richard A.Smith Meehan M.Smith Address(number and street) Address(number and street) 5110 Bassett Ave 5110 Bassett Ave Clly,state,and ZIP Code City,stale,and ZIP Code Evansville,IN 47715 Evansville,IN 47715 Country (.3-'" Country US US p ..._._ YES NO CONDITION YES NO CONDITION m 1.Will this property be the buyer's primary 0 3.Homestead it c_ © residence? 0 M 4.Solar Energy Heating or Cooling Syo H ci 5.Wind Power Device c k-1 2 Does the buyer have a homestead to be vacated iv cv for this residence? If yes,provide address: © OD 6.Hydroelectric Power Device r..) el � � 7.Geothermal EnergyHeatingor Coo_ ce C) dross(nu or and street} 0 ® -i t i 1 U ' . - -t- Arc-. �w © ,oly,state,and ZIP a cot my l ��•vc�, � 4 � 5 26-11-17-400-004.597.021 m `Q Under penalties of perJry,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete O