HomeMy WebLinkAboutHomestead_GasawayH.PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Ac
Company Email Address
.. orders(cD.hom,
Telephone Number
( 812 ) 461-6399
Address (number and street, city, state, country, and ZIP Code)
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document Seller 2 - Name as appears on con Xc cument
Quest Trust Company, FBO Richard W. Smith IRA 4371611, now known
Address (number and street) Address (number and street)
2160 W 1300 South
City, State, and ZIP Code City, State, and ZIP Code
Haubstadt, IN 47639 / �+
Country Country u
uS G
TTelehone Number Email Address N Q elephone Number
Email Address60-sdira@inspirafinancial.com ) Cij�T )
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, nd complete as
required by law, and is prepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies th alue 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
of Seiler
Signed (mm/dd/yyyy) I Printed Name of
Date Signed
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
Address (number and street) I Address (number and street)
City, State, and ZIP Code n ^ I City, State, and ZIP Code
FEmail
untry Country
us
Address Telephone Number Email Address Telephone Number
ylargasaway516@gmail.com ( 812 ) 677-6760 ( )
Idontifv all of those that aDDIV:
rursuam [o N, O- I. 1- 1-, u,c v -, - ---- --
YES NO CONDITION
- - - - -
YES NO CONDITION
1. Will this property be the buyer's primary
® O 3. Homestead
® residence?
O ® 4. Solar Energy Heating or Cooling System
O ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
E) ® 6. Hydroelectric Power Device
O ® 7. Geothermal Energy Heatingor Coolin/ Device
kAddr�;:s:(n,mber and street)
Ig
_� _ 1L� -J%` ��� -1 -`I
y, ate, 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 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of
information to be provided, commits a Level 5 felony. (Note: Both spouse's
transferred real property, or omits or falsifies any required
information, SSWDriver's License/ID/Other Number is necessary only if a Homestead Deduction is being filed.)
Si n
ure Buyer 1
Signature of Buyer 2/Spouse
d L a Name-6Muyer 1 Sign Date ( M//D /YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
12) oq.(J
Skylar Gasaway
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SS N/Driver's LicensellDlOther Number
U
Page 3
H:PRE,PARER _
Preparer of the Sates Disclosure Form
Title
Milton Norman
SeftlernentAgent
Company
Email Address
Telephone Number
Hometown Title, LLCorders(ahomelowntltles.co
( 812 ) 461-6399
Address (number and street, city, state, country, and ZIP Code)
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
I:SI.eR(s)/GRANroR(s)
Sellerl — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Quest Trust Company, FBO Richard W. Smith IRA 4371611, now known s
Address (number.and street)
Address (number and street)
2160 W 1300 South
City, State, and ZIP Code
City, Smote, and ZIP Code
Houbsladl, IN 47639
Country
Country
us
Email Address
Telephone Number
Email Address
Telephone Number
sdlra@insplraflnancial-com
( ' I a �J _
( )
ponaltles.of-perjury„theinhycartlty this SalaiDlecloauro, tc the best.of my knowiadga;and ballef in,truei.correct, and campleta:as
.Under,
required -by, few and laprapared in aceordanca.with [C-6-..1 1 5.5. A. person Who knowingly: and tntaintionalty NfAlfios Urevafua oftrantcterred:
reaRproperty;:or omits or faisf es any: Informatiortrequired4o;tie provkied;.commits a1fiveliS'falony: -
Slgnature of Seller
Signature of Seiler
Printed Name of Seller
Date Signed (mmlddlyyyy)
Printed Name of Setter
Date Signed {mmkldlyyyy}
MGY Yet S �UvtSSeliV1
45(1312�2CD
.J';.:BUYER(S)/GRAN�Et3}'— APPLICATION FOR'PROPERTL ( TAX IC]ETJ7IFYALi. TH;4'f APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer
Buyer 2 — Name as it appears on conveyance document
Sk lar Gasswa
Addreas (number and street)
Address (number and street)
City, State, and ZIP Code
City. Slate, and ZIP Code
Country
Country
us
Email Address
Telephone Number
Email Address
Telephone Number
skyiargasaway516Qgmail.com
( 812 ) 677-6760
)
Purauantto IC a3-1: L=12 4,;tha 321as`Dlsclosura Form mayus be ed,to.apply:%r. certaln.deducffons tdentify:aliiofthoae that apply:
YES NO CONDITION
YES NO CONDITION
1, Will this property be the buyer's primary
® O 3. Homestead
® O residence?
p ® 4. Solar Energy Heating or Cooling System
O ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
D O for this residence? If yes, provide address:
❑ ® 6. Hydroelectric Power Device
O ® 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, and ZIP Code County
Undar.panalfles of pe ju yi 1.hareby:certity: that this Sales. Disclosum, to'the best of.myknowl®dge and belief, is true; correct,.and.complate':
as: ratiulred by:taw,:and ls: prepared in accordance with IC 6.1 A-54., A.person.who knowingly. and linent3onally falsities the yaius of
transferred real proparty,'or:omlts'oY_falsifies:anyJnfarmation ra4uired to be prav1d0 ,comaetlts p LeMil.6 fafany: (Molar BDthspousa's
lnfarmaHen;:SSI�NDrl►fare+lleaned►D/t7thor±Numbartsnacessary;anfy!/a:HomoateatlrDeducNan-Jsbeing�filad;) -
Signature of Buyer 1
Signature of Buyer 2/Spotise
Printed Legal Name of Buyer 1 Sign Date (MMIDOM)
Printed Legal Name of Buyer 2/Spouse Sign Date (MMfOD/YY)
Skylar Gasaway
Last 5 Digits of Buyer 1 SSNIDrfver's L cense1ID/Dther Number
Last 5 Digits of Buyer 21Spouse SSN/Driver's LlcensellD/Other Number
Page 3