HomeMy WebLinkAboutHomestead_GehlhausenH. PREPARER
Preparer of the Sales Disclosure Form
Title
Kris Coon
Escrow Officer
Company
E-mail Address
Telephone Number
Regional Land Title
kris@regional-It.com
(812) 470-1300
Address (number and street, city, state, country, and ZIP Code)
4600 Washington Avenue, Suite 102, Evansville, IN 47714
I. SELLER(S)IGRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2— Name as appears on conveyance documen
Ryan Dean Pace
Address (number and street)
Address (number and street) 3®�c
429 N Gibson Street
U
City, State, and ZIP Code
City, State, and ZIP Cod
Princeton, Indiana 47670
Country
Country COUN
UNTY
AUDITO
E-mail Address
Telephone Number
E-mail Address
Telephone Number
ryan_pace@hotmail.com
(270) 875-2020
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.
Si re
Signature of Seller
Printe Name of Seller
Dat ed (mm/dd/yyyy)
Printed Name of Seller
Date d (mm/dd/yyyy)
Ryan Dean Pace
July 2026
July 2026
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
Keyanna Gehlhausen
Address (number and street)
Address (number and street)
316 N Gibson Street
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, Indiana 47670
Country
Country
E-mail Address ne mb j�
E-mail Address
Telephone Number
' \J
Fh{• ant to IC-1.1A2.44, t Sales Disclosure Form maybe used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
M ❑ 3. Homestead
1. Will this property be the buyer's primary
z ❑
residence?
❑ Z 4. Solar Energy Heating or Cooling System
❑ m 5. Wind Power Device
❑ 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)
`� _ 07 _ K) 1' � ` `
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/1D/0ther Number is necessary only if a Homestead Deduction is being filed.)
Signature a of Buyer T
Signature of Buyer 2/Spouse
Printed Leg I Name of Buyer 1 Sign D M1 M/owy)
Printed Legal Name of Buyer 2/Spouse Sig MM/DD/YY)
Keyanna Gehlhausen July , 2026
Jul 2026
Last 5 'sot Buyer 1 er's i enss11D1Q1h Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
MI L
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