HomeMy WebLinkAboutHomestead_Smith (3)ID
H.PREPARER
Preparer of the Sales Disclosure Form
Title
Milton Norman
Settlement Anent
Company Email Address Telephone Number
o etown Title LLC orders hometowntitles.com ( 812 ) 461-6399
Address (number and street, city, state, country, and ZIP Code)
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
1. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears o conveyance document
Nugget Properties, LLC
Address (number and street)
Address (number and street)
3162 S 650E
City, State, and ZIP Code
City, State, and ZIP Code
Francisco, IN 47649
APR
Country
Country :?
US
Email Address
( phon)e I bar
Email Address
GISON G�
elephone Number
;'
Under penalties of perury, I hereby certify this Sates Disclosure, to the best of my knowledge and belief, RVLrGAWrrect'and complete as
Salue transferred
required by law, and Is prepared In accordance with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies the of
real property, or omits or falsifies any information required to be provided, commits a Level 5 felony.
Igrlajure of erg
Signature of Seller
Printed Name bf Seller Date Signed (mm/dd/yyyy)
Printed Name of Seller Date Signed (mmlddlyyyy)
Richard J. Georges Jr., Member O Y" i ° 2.02.�
— L-1
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
Ronald Scott Smith
Nancy Adalea Smith
A"qmber a street
Addres (ber nd street
Clh, Qtste, andZIP Code
L4
City, Siate�d ZIP Code
11 t
Country
Country
US
US
Email Address
Telephone Numba
Email Address
Telephone Number .w.
Pursuant to IC 6-1.1.12.44, the Sales Disclosure Form may be used o
apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
® O 3. Homestead
® O residence?
O ® 4. Solar Energy Heating or Cooling System
O IN 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
O for this residence? If yes, provide address:
O ® 6, Hydroelectric Power Device
O ® 7. Geothermal Energy Heating or Cooling Device
Address (nu r st )
J���
26-13-26-300-000.493-006
City, State, and ZIP CCo e('� `,�' �^ ��
VNVI. ('YN 6
• �ounty
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, Is true, correct, and complete
in with IC 6-1.1-5.5. A person who knowingly and Intentionally falsifies the value of
as required by law, and is prepared accordance
transferred real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note. Both spouse's
i
information SSWDr' er's License(1DIOt umber is necessary oniy #a Homestead Deduction is being filed.)
Signature of uye�}1 f
Signature of Buyer 2/Spouse
Printed'Legal Name of Buyer 1 Sign Date (MMlDD/YY)
.�
Printed Legal Namevf dyer 2/Spouse Sign Date (MMlDWYY)
Ronald Scott Smith L/ " q
Nancy Adalea Smith
Last 5 Digits off B`)uyer 1 SSypN/Drivees License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver sLicense/ID/Other Number
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