HomeMy WebLinkAboutHomestead_Clark (8) H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers Escrow Officer
Company
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. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears on conve ment
Ryan Coomer
Address(number and street) Address(number and st et)IL
6136 W. Stalheim Ave.
City, State and ZIP Code City, State and ZIP Code MAR 2+6,20/2
Owensville, IN 47665
Country Country c�. . _./ Z.Y AVDA'"'�•/CR
United States of America ®10sGN t.OtJN7
E-mail address mail address Telephone number
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.
na eller 3 Signature of Seller
Printed N J e of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Ryan Coomer 3/18/2022 3/18/2022
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
Dillion J. Clark Marissa H. Clark
Address(number and street) Address(number and street)
904 Stonebridge Rd. 904 Stonebridge Rd.
City, State and ZIP Code City,State and ZIP Code
Evansville, IN 47710 Evansville, IN 47710
Country Country
United States of America United States of America
for certain deductions.Identify all of those that apply:
YES/ NO CONDITION YES NO CONDITION
O . Will this property be the buyer's primary residence? ❑ 3. Homestead I❑ 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for this ❑ p 5. Wind Power Device
residence? If yes,provide address: ❑ 2 6. Hydroelectric Power Device
Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
City,State,ZIP code, and county
6-U-31 -300 -0014- 23 -021
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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