HomeMy WebLinkAboutHomestead_Smith (2)K PREPARER
Preparer of the Sales Disclosure Form
Kris L Coon
Title
Escrow Officer
Company
Regional Land Title Company
E-mail Address
Kris@regional-It.com
Telephone Number
(812) 470-1300
Address (number and street city, state, country, and ZIP Code)
4600 Washington Avenue, Suite 102, Evansville, IN 47714
I. SELLER(S)IGRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Zheng Properties LLC
Seller 2 — Name as appears onjhneyance document
A {nurnb�r sir) y�' `V
T��
Address (number and street)
Cit 1e�1nI(� bode yj —i � �
City, State, and ZIP Code ,9p�41
Country
Country
E-mail Address
hone Num r ,, .{
E-mail Address p0 Q
(i� .
Telephone Number
Under penalties of perjury, I hereby certify this Sales Qisclosurs, ko the best of my knowledge and true, correct and complete as
required by law, and Is prepared In accordance with IC 6-1.1-5.6. A person who knowingly and Intentlo tfies the value of transferred
real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. !�
Signature of Seller
i
Signature of Seller
Printed Name of Seller
Zheng Properties LLC
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M .20
Printed Name of Seller
Date Signed (mmfddlyyyy)
, 20
J. BUYER(S)/GRANTEE(S) — APPLiCATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY ALL THAT APPLY
Buyer 1 - Name as It appears on conveyance document
Bryce Smith
Buyer 2 - Name as it appears on conveyance document
d e ..(num �
Address (number and street)
C' , t te, and ZJP Code
�� ®
City,
Y, State, and ZIP Code
Country
Country
E-mail Address
T n@ N er�
E-mail Address
Telephone Number
Pursuant to IC 6-1.1-12-d4, the Sales Diselosu a Form may be used to apply for certain deductions. Identify all of those that apply,
YES O CONDITION
YES NO CONDITION
❑ 3. Homestead
❑ F300""4. Solar Energy Heating or Cooling System
❑ s 5. Wind Power Device
❑ E�" , Hydroelectric Power Device
❑ 'ate 7. Geothermal Energy Heating or Cooling Device
O7 -,-03 -Oca . �,_A9 - Cog
❑1. Will this property be the buyer's primary
residence?
2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
s ' um
a
reet
C.b - -
ta hnd
1 County y- l Q
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: Bath spouse's
Information, SSN/Driver's License/ID10ther Number is necessary only if a Homestead Deduction is being filed.)
Si lure of Buys 1
.� L
Signature of Buyer 2/Spouse
Panted Legal Name of Buyer 1 Sign Date (MM/DI MO
Bryce Smith , 20
Printed Legal Name of Buyer 2/Spouse Sign Date (MMIDDIYY)
.20
Las is f Buyer 1 SSN/Driver's License/ID/Other Number
2 `.
Last 5 Digits of Buyer 2/Spouse SSN/Drivers LicensellD10ther Number
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