HomeMy WebLinkAboutHomestead_Moore (2)H. PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent
Company
Email Address
Telephone Number
Hometown Title LLC
orders@hometowntitles.com
( 812 ) 461-6399
Address (number and street, city, state, country, and ZIP Code)
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
1. SELLER(S)IGRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 —Name as appears on conveyance document
In The Matter of the Guardianship of Dakota Allen Moore, an incapacitate
Address (number and street)
Address (number and sVapt)
637 S 2nd Ave Apt. 103
- -7 S) ,P)�a ? x �CX..
City, State, and ZIP Code
City, Sta ; arid ZIP Code
Princeton, IN 47670s
s . - 1�4j 1't +_ t� '"( 0�� s
Country ^`
Country
US
E ,ail lllddress r
J
u pit
Telephone Number -y
. Email Address
Telephone Number
.'LX
�•
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 r falsifies any information required to be provided, commits aAevel 5 felony.
Signature, f,,%etler
Signature of S r;
Printed Dame of Self6r "' - ' "
Date Signed (m /dd/yyyy)
Printed Name of t;el r
Date Signed (mm/,dd/yyyy)
Eric Moore, Co -Guardian
-`I I (@
.{ y`a
J. BUYER(S)/GRANTEE(S) -APPLICATION FO PROPERTY TAX DEDUCTIONS - ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appArS o c veya a fl ument
wk
Jacob R. Moore
Address (number and street)
Address (number and streetjI
1405 S Jefferson Ave
VIA
City, State, and ZIP Code
City, State, and ZIP Code 26
Princeton, IN 47670
Country
Country /$g ON Cp tea,
US
(JAI
Email Address
Telephone Number
Email Address Ut?lT
elephone Number
/"`r, '. s i�` i. =:3." ;,t,�,l'• .�
( 812 ) 677-7283
( )
Pursuant to IC 6-1.1-12-44;jthe Sales Disclosure Form_ may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
IN ❑ 1. Will this property be the buyer's primary
(9 0 3. Homestead
residence?
❑ ® 4. Solar Energy Heating or Cooling System
❑ (2)5. Wind Power Device
❑( 2. Does the buyer have a homestead to be vacated
'" `+. for this residence? If yes, provide address:
❑ ® 6. Hydroelectric Power Device
❑ ® 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, and ZIP Code County
Q
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/1D/0ther Number is necessary only if a Homestead deduction is being Fled.)
nature of Buyer 1
Signature of Buyer 2/Spouse
p' inted Legal Name of Buyer 1 Sign Dale (M /DD )
-1
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
'Jacob R. Moore db a-"
Last 5 Digits of Buyer 1 SSN/Ddver's License/ID/Othet Numb r
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
' 1
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