HomeMy WebLinkAboutHomestead_BaileyH. PREPARER
Preparer of the Sales Disclosure Form
Title
Kris L Coon
Escrow Officer
Company
E-mail Address
Telephone Number
Regional Land Title Company
Kris@regional-It.com
1(812) 470-1300
Address (number and street city, state, country, and ZIP Code)
4600 Washington Avenue, 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
Haylee R. Smith
Bryce A. Smith
Address (number and street)
Address (number and street)
418 N Race Street
418 N Race Street
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
_
Princeton, IN 47670
Country
Country
United States of America
United States of America
E-mail Address
Telephone Number
E-mail Address
Telephone Number
hayleeneufelder@gmail.com
(812) 664-4272 __Lb
rycesmith903@gmail.com
(812) 632-1723
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 rope rty OnlitSor falsifies any Information requir dto be provided, commits a Level 5 felony,
-
I atur all ..
Sign re of Selle
r
Printed a of StIler Date i ned mm1dd/yyyy)
"
Pr a ame of Set er
Dal Signed {mm/ddIYYYY)
Haylee R Smith
Bryce A. Smith
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT AP LY
Buyer 1 Name 1 sA'reap
rs co4eeyyance document
Uri
Buyer 2 - Name as it appears veyance document
Ja.dda»tittaSr lj
Address (number and street)
Address (number and street
404 N Church Street
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648 _
!��
ir
Country
Country `®6�
United States of America
E-mail Address
Telephone Number
E-mail Address G/gS Telephone Number
jaddafaith04@gmall.com
812 549-5928
CSC'
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. I e i se that apply.,
YES NO CONDITION
YES NO CONDITION %OlVv
y
❑X ❑ 3. Homestead
Will this property be the buyer's primary
El
residence?
residence?
❑ 0 4. Solar Energy Heating or Cooling System
❑ 0 5, Wind Power Device
❑ - 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ 0 6. Hydroelectric Power Device
❑ Q 7. Geothermal Energy Heating or Cooling Device
26-19-18-301-000.439-026
Address (number and street)
City, State, ZIP code, and County
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/Drivers License/ID/Other Number is necessary only if a Homestead Deduction is being filed.)
Signature of Buyer 1
Signature of Buyer 2/Spouse
61
PrirfWd Legal Naraa ojf uy r 1
Jadda'F3tfty
Sign Date ( M/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Last 5 Digits of Buyer 1 SSN/Driver's Li nse/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
SSN: 4-0916
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