HomeMy WebLinkAboutHomestead_BackerH. PREPARER
Preparer of the Sales Disclosure Form
Title
Allyn Tresenriter
Escrow Officer
Company
Email Address
Telephone Number
Foreman Watson Land Title
ATRESENRiTER@FW-LT.COM
(812 ) 909-4643
Address (number and street, city, state, country, and ZIP Cade)
7412 Eagle Crest Blvd Evansville, IN 47715
I.5MLER(S)M RANTOR(S)
Seller 1- Name as it appea rs on conveyance document
Seller 2- Name as appears on conveyance document
Charles Michael Rainey
Amy Sue Rainey
Address (number and street)
Address (number and street)
5.
2211 Westpw 160 S
2211 west ®tom
City, State, and ZiP Code
City, Slate, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
USA
USA
Email Address
Telephone Number
Email Address
Telephone Number
(812 ) 385-8512
(812 ) 677-OB79
Under penalties of perjury, I hereby certify this Sales Disclosure, to the beat of my knowl(fd[ge and belief, Is true, correct, and complete as
required bylaw, and to prepared In accordance with IC ti-1.1.6.b: A person who knowingly and Intentionally falslfies the value of Iran eferred
real property, or omits of falsifies any inforrnatton required to.be provided, commits a level t; felony.
S' natu a Seller
Si ature f Seller -
�� Q
P fed Name of Seller
Date Si ddlyyyy)
P ted Nan a of Seller
Mate Signed (mm1dd1yyyy)
Charles Michael Rainey
04 026
Amy Sue Rainey
104/27/2026
J. BUYER(s)MRANTEE(S) - APPLICATION FOR PROPERTY TAx DEDUCTIONS - ioENTIFY ALL THAT APPLY
Buyer 1 - Nance as it appears an conveyance document
Buyer 2 -- Name as it appears on conveyance document
Ryan Z. Backer
Address (number and street)
Address (number and streat)
1094 East TaPlown Road
City, State, and ZIP Code
City, State, and ZiP Code
Princeton, IN 47670
ev
Country
Country c1111
USA
USA
Email Address Telephone Numberp f�3 Email Address Teleph ber cv
backer -I 1 55@llve.com (8 t 2 ) 619-907-53
Pursuantto IC 6-1.1-12.44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those t p y: -
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
0 ❑
0 ❑ 3. Homestead
residence?
❑ 0 4. Soler Energy Heating or Cooling System
❑ ❑ 5. Wind Power Device
❑ ED 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ 0 H. Hydroelectric Power Device
❑ ❑i 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
/ _ — I a-Lo5 - , too - oo . r b � - rya 1
City, State, and ZIP Code County
Under penalties of perjury, I hereby eertTfy that this Sales Disclosure, to the beat of my knowledge and belief, is true, correct, slid complete
as required by law, and Is prepared in accordance with IC 6-1.1 6:6. A person who knowingly and Intentionally falsifies the value of
transferred real property, oromits orfataifies any Information required to be provided, commits'a Level 5 felony. (Note. Both spouse's
Information, SSiWDriversVicen iA/OtheriVumberisnecessaryonfyllaHomasteadDeductionIsbeing!lied.)
Sig ature of By 9
Name
Signature arBuyer 2lSpouse
f rin d Legal f Bu r 1 Sign Date (MWDDIYY)
Printed Legal Name of Buyer 21Spouse Sign Date (MMIDD/YY)
Ryan Z. Backer 04/27/2026
Last 5 Digits of Buyer i SSWDdver's LlcensellD/Other Number
test 5 Digits of Buyer 2/Spouse SSN/Driver's LicensellD/Other Number
Last 5 of SSN: 89120
Last 5 of SSN:
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