HomeMy WebLinkAboutHomestead_Ellis (2)H.;PREPARER
Preparer of th/e� Sales Disclosure Form
Title
Company
Email Address
Telephone Number
Address (number and street, city, state, country, and ZIP Code)
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Seller 1 - Name as.itappears on conveyance document
Seller 2 - Name as appears on conveyance document
Address (number and street)
Address(numberand street
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City, State, and.ZIP Coder j /
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City, State, and ZIP Code
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Country
Country
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Email Address
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Telephone Number
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Email Address
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Telephone Number
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t7nder;penafhes of -perjury, l hereby certify this Sales:Disclosure, to.the best b . my knowledge°and belief; is true : correct ,and�complete�as
required=by--law; anii is prepared in accordance withaC 6 1 1=5 5 A person who knowingly and'intentionailyfalslfies thewalue,of transferred
real property, or omi . orfalsifies any mformation,cequired-to.fie'.provided, commits a:Leyel 5;felony.-
Signature of Seller
Signature of Seller
Printed Na a of S er
Date Sign d (mm/dd/yyyy)
Printed Oame of Seller
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Date Signed (mm/dd/yyyy)
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J: BUYRANTEE(S) - APPLICATION FORPROPERTY TAX DEDUCTIONS -IDENTIFY ALL THAT APPLY
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uyer 1 - Name as ifappears on conveyance document
Buyer 2 - Name as It appears on conveyance -document
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ddress (numb and street)
Address. (number and street)
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City, State, and ZIP Code
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City,. State, and ZIP Code
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Country
Country
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Email Address
Telephone Number
Email Address hone Number
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Pursuant=to lC_ .1 1 ,12 44,ahe $ales Disclos.ure.Form may lie used toappiy'for certain deducti Identify.all<o atapply:
YES NO CONDITION
1. Will this property be the buyer's primary
Y QSK�,.NO CONDIfIbw
Homestead)
residence?r
Energy Heating ys .'
❑ 5 �IGsice orlem
6. H.ydroelecfric10 r _"' vice
❑' KA 7..Geothermal. EnergNeating or Cooling Device
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2. Does the buyer have a homestead to be vacated
❑ for this residence? If yes, provide address:
Address (number and street)
City, State, and ZIP Code County
p p i ry,.a hereby certify that this :Sales Disolosure-ao the:.6est of m r Howled a and belief is true, correct, and com lute
O6br enaltiespf er u Y k ;. 9 p .
as required bylaw, and Is;prepared:,inarcordance with tC 6-1 1 5 5 A: person,who knowinglyand intentionally falsifies the yal.ue�of
transferred real;property, or=omits orfaisifres anysinformation required to be:provided; commits a Level5kfelony. (NOYe.Both•spouse's
anformatlon, SSN/Driver's;Llcense/ID/Other;Number;is necessary„only rf aHomestead,Deductfengis being filed )'
Signature of Buyer ���
Signature,.gf Buyer 2/ pous����'�, i
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Printed Legal me of Buyer 1 Sign Date (MM/DD/YY)
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Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
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Last 5 DI it of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/QIJX94a i Inanse/ID/Other Number
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