HomeMy WebLinkAboutHomestead_HaleH.PREPARER
Preparer of the Sales Disclosure Form
Title
Abbey Moore
Closing Agent
Company
Columbia Title, Inc
E-mail Address
abbey@columbiatitlegroup.com
Telephone Number
(812) 471-8563 ext. 400
Address (number and street, city, state, country, and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLER(S)IGRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Bryan Joseph Carroll
Amber Nicole Carroll
Address (number and street)
Address (number and street)
6555 West Evening Song Lane
6555 West Evening Song Lane
City, State, and ZIP Code
City, State, and ZIP Code
Owensville, IN 47665
Owensville, IN 47665
Country
Country
USA
USA
E-mail Address
heavyduty176@ 9yahoo.com
Telephone Number
(812) 215-9836
E-mail Address
acarroll4281 @yahoo.com
Telephone Number
(812) 215-9836
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.
Signature of Seller
Signature of Seller
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Ca
Printed Narffe of Seller
Date Signed (mm/dd(yyyy)
Printed Name of Seller
Date Signed (mrn/dd/yyyy) -.
Bryan Joseph Carroll
04/09/2026
Amber Nicole Carroll
04/09/2026
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL T 4 PPLY
Buyer 1- Name as it appears on conveyance document
Buyer 2 - Name as it appears on conveyance nt
Chase Hale
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Address (number and street) c�
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CI ZIP de
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City, Slate, and ZIP Code --
Country
Country
USA
E-mail Address
Telephone Number
E-mail Address
Telephohe Number 4
chasehale07@icloud.com
812 499-4134
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to
apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
❑ 3. Homestead
❑ 1. Will this property be the buyer's primary
residence?
❑ 4. Solar Energy Heating or Cooling System
❑ 5. Wind Power Device
Does the buyer have a homestead to be vacated
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for
for this residence? If yes, provide address:
❑ 6. Hydroelectric Power Device
❑ 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, ZIP code, and County
26-19-08-400-001.030-025
Under penalties of perjury, I hereby certify that 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. (Note: Both spouse's
Information, SSN/Driver's LicenseAD10therNumber Is necessary only if a Homestead Deduction is being filed.)
Sig a re 8 yer 1 Signature of Buyer 2/Spouse
Pilnte . Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Chase Hale 04/09/2026
04/09/2026
Last 5 Diglls Of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
76750 a
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