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HomeMy WebLinkAboutHomestead_Snyder (2)n. rKtrAKtK Preparer of the Sales Disclosure Form Christa D. Tracey Title Escrow Officer Company E-mail address Southwestern Indiana Land Title christa@swinland.com Address (number and street, city, state, country, and ZIP code) 605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713 J CLLCRtJIll7 KAN I UK(b) Seller 1 - Name as it appears on conveyance document Randall Hurst Address (number and street) 908 S Gibson St City, State and ZIP Code Princeton, IN 47670 Country United States of America Email Address Telephone number (812) 425-0055 Seller 2 - Name as it appears on conveyance document Haaress (number and street) City, State and ZIP Code k,ountry Telephone Number I Email Address Telephone Number 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 requir d to be provided, commits a Level 5 felony. Sinnatnrn of Q�LL - Y - — i1 i of S Randall Hurst Date Signed (mm/dd/ yyyy) Signature of Seller r-iirneu name of 6eiier /,--/-a& 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 appe son Bram Snyder Address (number and street) Address (number an e , y 407 E Old Petersburg Rd. City, State and ZIP Code City, State and ZIP Code Princeton, IN 47670 X\S� IDate Signed (mm/dd/yyy a nce document tioti� � Country 1w"^ United States of America Country Email Address Telephone Number Email Address gG (812) 677-2059 �,�� Telephone Number Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply: YES NO CONDITION © ❑ 1. Will this property be the buyer's primary residence? ❑ ',�W 2. Does the buyer have a homestead to be vacated for this residence? If yes, provide address: Address (number and street) City, State, and ZIP Code County IN YES NO CONDITION Q ❑ 3. Homestead ❑ Ef 4. Solar Energy Heating or Cooling System ❑ IZI 5. Wind Power Device ❑ 0 6. Hydroelectric Power Device ❑ M 7. Geothermal Energy Heating or Cooling Device LQ�I �1''-;�®I-Cla-'-.Q: _-C) 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, 5SN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.) Signature of Buyer 1 Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY) Bram Snyder Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number SSA -7 -WcdO2- DL# ztQ a -12Z5 Signature of Buyer 2/Spouse rnniea Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY) Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number Page 3