HomeMy WebLinkAboutHomestead_HinkelH. PREPARER
Preparer of the Sales Disclosure Form
Title
Kris L Coon
Escrow Officer
Company
E-mail Address
Telephone Number
Regional Land Title Company
Kris@regional-It.com
(812) 470-1300
Address (number and street city, state, country, and ZiP Code)
4600 Washington Avenue, Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1 — Name as It appears on conveyance document
Seller 2 — Name as appears on e&vey ce ocutt
Ellis Estates LLC
Address (number and street)
Address (number and street)
10044 Browning Road
AIA
City, State, and ZIP Code
City, State, and ZIP Code 0?6
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Evansville, IN 47725
Country
Country
United States of America
G16S Q
E-mail Address
Ilne
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E-mail Address N
umber
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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 6.1.1-5.5. 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.
Signature of Seller
Signature of Seller
Printed Name of Seller
Date Signed (mmlddlyyyy)
Printed Name of Seiler
Date Signed (mmlddlyyyy)
Brian S. Ellis, Manager
S o7
J. BUYER(S)iGRANTEE(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
Moses Hinkel
Danielle Hinkel
Address (number and street)
d ss {arnbe nd street)
307 South McCreary Street
(� "
City, State, and ZIP Code
S at nd IP co
Fort Branch, IN 47648�
Country
Country
United States of America
E-mail Address
Telephone Number
E-mail Address LTkle e e
moseshinkel@icloud.com
812 677-3181
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all a those that apply:
YES NO CONDITION
YES NO CONDITION
❑X ❑ 3. Homestead
1. Will this property be the buyer's primary
® ❑
residence?
❑ 0 4. Solar Energy Heating or Cooling System
❑ ❑X 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
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for this residence? If yes, provide address:
❑ 6. Hydroelectric Power Device
❑ ® 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
.- 1 7 —2 1-I —d -- Cc-0 aGo -(
City, State, ZIP code, and 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 6-1.1-5.5. 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: Both spouse's
Information, SSN/Driver's LCcansel101Ot/WrNumber lsRecprAsary only if Homestead Deduction is being riled.)
Signature of Buyer 1 f. i f{j f�� ;� G
Signature of Buypr 21Sp use
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Printed Legal Name of Buyer 1 Sign Date (MMIDD/YY)
Pr Legal Name of Buyer 2/S se Sign Date (MMIDDNVY
'6
Moses Hinkel
anielle Hinkel —
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Lasi5 Di its of Buyer 2/Spo. se 5SN/Driver's Llc4nseli /Other Number
SSN: 9-3576
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