HomeMy WebLinkAboutHomestead_Bean (2)H.PREPARER
Preparer of the Sales Disclosure Form
Title
Chelsea E. Morell
Closing Agent
Company
Columbia Title, Inc
E-mail Address
chelsea.morell@columbiatitlegro
Telephone Number
(812) 471-8563 ext. 403
Address (number and street, city, state, country, and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appe ance document
Adam C. Riley
Address (number and street)
Address (number and street)
13901 Martin Road
City, State, and ZIP Code
City, State, and ZIP Code A/ 0 n
Evansville, IN 47725
J
Country
Country
USA
E-mail Address Telephone Number E-mail Address O C Telephone Number
N OU�r'A
Ad ImRiley12@gmail.com (812) 632-0267
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, &rrect and complete as
IC 6-1.1-5.5. A who knowingly and intentionally falsifies the value of transferred
required by law, and is prepared in accordance with person
real property, or omits or falsifies any information required to be provided, commits a Level 5 felony.
Sig r''e��. ff Seller
'
Signature of Seller
Printed Name of Seller Date Signed (mm/dd/yyyy)
Printed Name of Seller Date Signed (mm/dd/yyyy)
Adam C. Riley 06/05/2026
06/05/2026
I 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
Tyler Bean
Address (number and street)
Address (number and street)
11553 County Road 150 South
City, State, and ZIP Code
City, State, and ZIP Code
Oakland City, IN 47670
Country
Country
USA
E-mail Address
Telephone Number
E-mail Address
Telephone Number
t_bean_09@hotmail.com
812 582-9429
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
YES NO CONDITION
❑X ❑ 3. Homestead
1. Will this property be the buyer's primary
❑ residence?
❑ ❑X 4. Solar Energy Heating or Cooling System
❑ 05. Wind Power Device
2. Does the buyer have a homestead to be vacated
❑ EN for this residence? If yes, provide address:
❑ 0 6. Hydroelectric Power Device
❑ Q1 Geothermal Energy Heating or Cooling Device
Address (number and street)
�7..
�� - )i ` A -�00 - 0 ' g�� ` ���
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 License/ID/Other Number is necessary only if a Homestead Deduction is being filed.)
Signatur u e
Signature of Buyer 2/Spouse
Printed Le Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Tyler Bean 06/05/2026
06/05/2026
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
SSN:1-7908
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