HomeMy WebLinkAboutHomestead_ReedH.PREPARER
Preparer of the Sales Disclosure Form
Title
Jamie E Smith
Escrow Officer
Company
Email Address
Telephone Number
e Title Service, LLC
closings@truetitlein.com
(812 ) 402-6555
dress (number and street, city, state, country, and ZIP Code)
1 Plaza E Boulevard, Suite 102, Evansville, IN 47715
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SELLER(S)IGRANTOR(S)
� I' 1 - Na as it a ars on conveyance document
Seller 2 - a e as appears on conveyanc document c
avtev- re
Address number and street)
Address (number and sir
et)
Cit State, and ZIP Code
, ( �1 M. I d 4" fi1�
City, State, and ZIP ode 'j
1� t I� I
C ntry i
auntry
Email Address
Telephone Number
-)(r
Email Address
Telephone Number p
( )� -
) d
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 6-1.15.5. A person who knowingly and intentionally falsifies the value of transferred
real property, or omits or falsifies an information required to be provided, commits a Level 5 felony.
Signature of Sell T
Signal of S ter44
i ed Nam of S
Dattn ignejd mm/ddiyyyy)
to me of Her Date Signed (mm/ddlyyyy)
BUYERS)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY A THAT APPLY
Buyer 1 - Name as it a pears on conveyance document
Buyer 2 - Name as it appears on convey d u nt
t7
Add s (n her and4treet
Address (number and street)
Cit State, and ZIP Code
City, State, and ZIP Code
`ntry
C
Country
Email Address
Telephone Number
rL
Email Address ON G0ephpfe
Number
Pursuant to IC 6-1.1.12.44, the Sales Disclosure Form maybe used to apply for certain deductions. Identify all of those t !�
YES NO CONDITION
YE NO CONDITION
O 1. Wall this property be the buyer's primary
O 3. Homestead
residence?
p p 4. Solar Energy Heating or Cooling System
D (a 5. Wind Power Device
O 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
p O 6. Hydroelectric Power Device
p O 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, and ZIP Code 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 6-1.15.5. 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 L'censeliDlOther Number is necessary only if a Homestead Deduction is being filed.)
Signature ��
Signature of Buyer 2/Spouse
1w L o Z--�-
ri Le al Na a of B F 1 Sign Dal (M D! Y)
Printed Legal Name of Buyer 2/Spouse Sign Date (MMlDDlYY)
Las 5 igits of Buyer S Dr, fiicens vers e/IDlOther Number
Last 5 Digits of Buyer 21Spouse SSN/Driver's License/IDlOther Number
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