HomeMy WebLinkAboutHomestead_Coleman (3)H. PREPARER
Preparer of the Sales Disclosure Form
Title
Matthew Jarvis
Escrow Officer
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
matt@swinland.com
(812) 425-0055
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLERS)/GRANTOR(S) j
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conveyan omment
J&B Loveless Co. LLC, an Indiana limited liability company
Address (number and street)
Address (number and street)
1330SCR75E
City, State and ZIP Code
City, State and ZIP Code
Winslow, IN 47598
ZJr 2
Country
Country
United States of America
G/g
Email Address
loveless1998@aol.com
Telephone Number
Email Address COU
T Number
�AUO
(812) 766-0964
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.
Sigr6e of eller
Signature of Seller
PrivOed Name of Seller
Date Sd m/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Justin Loveless, Managing Member
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
Makenna Coleman
Cain B Hill
Address (number and street)
Address (number and street)
8942 West State Road 65
8942 West State Road 65
City, State and ZIP Code
City, State and ZIP Code
Hazelton, IN 47640
Hazelton, IN 47640
Country
Country
United States of America
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
kennacoleman16@yahoo.com
(812) 664-6500
cainhi1166@icloud.com
(812) 664-6500
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
Y� NO CONDITION
0 ❑ 1. Will this property be the buyer's primary residence?
❑ 3. Homestead
❑ 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for this
residence? If yes, provide address:
❑ 5. Wind Power Device
❑ 6. Hydroelectric Power Device
vice
Address (number and street)
❑ V7. Geothermal Energy He or Cooling Device
L �+.��-/
l c)I I, l(0C�- c)c,
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 6-1.1-5.5. 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 if a Homestead Deduction is being filed.)
Signature of Buyer 1
Gt 'VLF
Signature of Buyer 2/Spouse
cow-,-)
Printed Legal Name of guyer 1 Sign Date (MM/DD/YY)
ly
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Makenna Coleman 2a
Cain B Hill
.0 1 cp
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
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