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HomeMy WebLinkAboutHomestead_DavisH.PREPARER Preparer of the Sales Disclosure Form Title Christina Lenfers Settlement Agent Company Email Address Telephone Number Bosse Title Company ( 812 ) 421-4000 Address (number and street, city, state, country, and ZIP Code) 4799 Rosebud Lane, Newburgh, IN 47630 I. SELLERS)/GRANTOR(S) Seller 1 — Name as it appears on conveyance document Seller 2 — Name as appears on conveyance document Jennifer L. Beumel Irrevocable Income Only Trust u/d/a May 3, 2022 Address (number and street) Address (number and street) 513 S. Eighth Ave. City, State, and ZIP Code City, State, and ZIP Code Haubstadt, IN 47639 Country Country us Email Address Telephone Number Email Address Telephone Number ( Bea) �f9R yllS 1 ( ) 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. ;Sjgnature of er-- Signature of Seller 1,P4r1WNafn&V Seller Date Signed (mm/dd/yyyy) Printed Name of Seller Date Signed (mm/dd/yyyy) Jarrod L. Simms, Trustee 1 05/12/2026 05/12/2026 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 Gabriel Davis Address (number anct street) Address (number and street) 513 5 4 City, tate, an IP odeV / City, State, and ZIP Code lO co Country Country Rj u5 c (� Email Address Telephone Number Email Address T le irmbef ciannajo@twc.com ( 812 ) 664-8744 Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all ofth a pplvi: YES NO CONDITION YES NO CONDITION 0 1. Will this property be the buyer's primary y O 3. Homestead residence? Q ® 4. Solar Energy Heating or Cooling System O ® 5. Wind Power Device O ® 2. Does the buyer have a homestead to be vacated for this residence? If yes, provide address: p (R ' 6. Hydroelectric Power Device Q (D 7. Geothermal Energy Heating or Cooling Device A-2ux - Do- bo o, ?85 - o© 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 6-1.145.5. 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, SSWDriver's Llcense/lD/Other Number is necessary only if a Homestead Deduction is being filed.) n re B 1 Signature of Buyer 2/Spouse Print9d Legal Nbmceof Buyer 1 Sign Date (MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY) Gabriel Davis 5/12/2026 05/12/2026 Last 5 Digits yer 1 SSN/Driver's License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number Page 3 sz m ;