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HomeMy WebLinkAboutHomestead_RaineyH. PREPARER Preparer of the Sales Disclosure Form Title Escrow Officer Kris L Goan E-mail Address Telephone Number company }iris@regional-ILCOm (812) 470-1300 Regional Land Title Company Address (number and street, city, state, country, and ZIP Code) Avenue, Suite 102, Evansville, IN 47714 4600 Washington I. SELLER(S)/GRANTOR(S) Seller 1— Name as it appears on conveyance document Seller 2 —Name as appea eyance document Ryan K. Meyer Address (number and street) Address (number and st 907 Sunniland Boulevard City. State, and ZIP Code City, Stale, and ZIP Code MAY Lehigh Acres, FL 33971 C Country �zs Country United States of America Telephone Number E-mail Address Telephone Number E-mail Address Tron432001 @gmail.Com (812) 664-1433 c')BS Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge an P and complete as in with IC 6-1.15.5. A person who knowingly and Intentionally f7aFCfurle value of transferred required by law, and Is prepared accordance 8rTys or omits or falsifies any information required to be provided, commits a Level 5 felony, of vilerSignature Z of Seller am IF Seller D e ' ned (mmlddlyyyy) Printed Name of Seller Date Signed (mm/ddfyyyy) Ryan K Meyer 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 Brandi Rainey r {n r am tree!) Address (number and street) 1 , Slate and ZIP Code r - i 10 �J City, State, and ZIP Code Country Country United States of America Email Address I ha e r E-mail Address Telephone Number [: Brandirainey545@gmail.com Pursuant to IC 64.1-12-44. the Sales Disc osure, Form may be used to apply for coosin deductions. Identify all of those that apply: YES NO CONDITION YES O CONDITION [] 3. Homestead 1. Will this property be the buyer's primary ❑ rasa ca? © 4. Solar Energy Heating or Cooling System ❑ ❑X 5. Wind Power Device ❑ Vfo. Does the buyer have a homestead to be vacated r this residence? If yes, provide address: ❑ 0 6. Hydroelectric Power Device ❑X 7. Geothermal Energy Heating or Cooling Device Address (number and street) City, State, ZIP code, and County Under penalties of perjury. I hereby a�this Sales Disclosure, to the best of my knowledge and belief, Is true, correct and complete as required by law, and Is prepared�naccordanFe with IC 6-1.1-5.5. A person who knowingly and Intentionally falsifies the value of be trans] ed real property, or o , osifies arty Information required to provided, commits a Level 5 felony. (Note: Both spouse's inKrrma ' n, SSN/Driv r',s Lic �. s her lytimber is necessary only if a Homestead Deduction Is being riled.) Sion to o t Signature of Buyer 2/Spouse Print al Name of yer 1 i gate /YY) Printed Legal Name of Buyer 2ISpouse Sign Date (MMIDD/YY) Brandi Rainey (� Last 5 of Bu r 15S river's Licenseli Other N mber Last 5 Digits of Buyer 2/Spouse SSN/DrivBes License/ID/Other Number SSN: It Page 3