HomeMy WebLinkAboutHomestead_Shoultz (2)L
H. PREPARER
Preparor of the Sales Disclosure Form
Tillie
Katie Felty
Escrow Officer
Company
Email Address
Telephone Number
Foreman Watson Land Title
kfelty@fw-It.com
( 812 ) 909-4543
Address (number and street, city, state, country, and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
1. SELLER(S)IGRANTOR(S)
Seiler 1 — Name as it appears on convoyance document
Seller 2— Name as appears on conveyance document
Han P. Sausser
Samantha A. Sausser
Address (num r
J
and t) �,
Address (number and st A n
I" e—,
City, 5ii , and ZI
Cod o
City, State, and ZIP Code
y
Country
Country
us
Lis
Email Address
Telephone Number
Email Address
Telephone Number
Psausser@otiVook.com
t 814 ) 655.1504
Tallpine6gardencenter@gmall.com gmall.com
( 814 ) 655-1736
Under penaltles of perjury, I hereby certify this Sales Disclosure, to the bestof my knowledge and belief, Is true, correct, and complete as.
required by law, and Is prepared in accordance with IL fi-!.i 6.6. A person who knowingly and intentionally falsifies the value of transferred
real property,zo .omits or falslfies any Information required to be provided comin Its a Level 6 felony..
S
Si lure of Seller
C
Printed Name of Se er
Data Signed (mrn/tld/yyyy'
Printed Name of Seller
Dale Signed (mm1dd/yyyy)
Harry P. Sausser
$l19/2$
Samantha A. Sausser
611912ti
J.' BuYER(S)IGRANTEE(S) — APPLICATION FOR PROPERTY TAX Da ouCTIONS — IDENTIFY ALL THAT APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it appears on crMunt
Camaron Ryan Shoultz
Address (number and street)
Address (number and street)
214 East 1st Street
City, State, and ZIP Code
City, State, and ZIP Code
JUL ®l
Oakland City IN 47660
20
Country
Country
u5
us
Email Address
Telephone Number
Email Address G18S
CC
umber
pack.man04@yahoo.com
(812 ) 582-3922
Nry
Pursuant to IC 6-1.1-12-44, the Sales Dlscloa'uee_Form maybe used t® apply for certain deductions. Identify all of those that app :
YES NO CONDITION
YES NO CONDITION
1. WIII this property be the buyer's primary
Q ❑
El ❑ 3. Homestead
residence?
❑ 0 4. Solar Energy Heating or Cooling System
[3 [ZI 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
❑
for this residence? if yes, provide address:
[3 ❑ 6. Hydroelectric Power Device
® ❑ 7. Geothem}al Energy Heating or Cooling Device
a� _ 1 �, _ l _ ` , �' �9 Z, 00)7
Address (number and street)
City, State, and ZIP Code County
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the beat of my knowledge and belief, Is true, correct, and complete
ae required by taw, and is prepared In accordance with IC 6.1.1-6.6. A porson who knowingly and Intentionally falsifies the value of
transferred real property, or omits or falsifies any Information required to be provided, commits a Level 6 felony. (Note, Both spouse's '
inforrirarld SAM4ver's Lfcense/IDlor erNumberIs necessary onty ffa Homestead Ooducdion le being filed.)
Si nat Buyer 1
Signature of Buyer 2/Sprnise
P i ed Legal Name of r ign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MMIDDNY)
Camaron Ryan Shoultz G119/2G
Las(5 Digits of Buyer 1 SSNIDriver's Liconse/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSNIDrivei's License/iD/Other Number
Las(5 of SSN: LI. 3 S
Last 5 of SSN:
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