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HomeMy WebLinkAboutHomestead_Loomis (2) H. PREPARER Preparer of the Sales Disclosure Form Title Scott Morris Escrow Agent Company Address(number and street,city,state,country,and ZIP Code) 4600 Washington Ave, Suite 102, Evansville, IN 47714 I. SELLER(S)/GRANTOR(S) Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document Lenora J Weber Address(number and street) Address(number and street) — (4) 5c)Ah Aq\ *� City, ate,and ZIP Code City,State,and ZIP Code yr;,r,czA-c.,k, -X) 41C97TJ 4 / Country Countryp© ,r 58�o a C...\\vEmail Address O,y()© Q ( ) Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belie; rrect,and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally • a value of transferred real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony. /T Signature of Seller Signature of Seller ©,Q Printed-Name of Seller Nk Date Signed(mm/dd/yyyy) Printed Name of Seller I Date Signed(mm/dd/yyyy) Lenora J Weber {IrQ0'a J. BUYER(S)/GRANTEE(S)—APPLICATION FOh 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 Derek Alexander Loomis Address(number and street) Address(number and street) © S 3-©.J a- SA- City,State,and ZIP Code t City,State,and ZIP Code �P Ni hLGlrwr•IT.n 1J 7b7© Country j� Country 3. Email Address certain deductions.Identify all of those that apply: YES NO CONDITION YES NO CONDITION XO 1.Will this property be the buyer's primary 0 3.Homestead residence? 0 © 4.Solar Energy Heating or Cooling System Does the buyer have a homestead to be vacated 0 © 5.Wind Power Device O for this residence? If yes,provide address: 0 © 6. Hydroelectric Power Device Address(number and street) 0 Q 7.Geothermal Energy Heating or Cooling Device City,State,and ZIP Code County 6-12 - O4- 'LI,n 4 -COO ,121 0 K Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct,and complete