HomeMy WebLinkAboutHomestead_BeltH. PREPARER
Preparer of the Sales Disclosure Form
Title
LaToya Woodruff
Closing Agent
Company
E-mail Address
Telephone Number
Columbia Title, Inc
(woodruff@columbiatitlegroup.co
(812) 471-8563
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 appears on conveyance document
Joyce L. Kruse
Address (number and street)
Address (number and street)
704 East Strain Street
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648
Country
Country
USA
E-mail Address
Telephone Number
E-mail Address
Telephone Number
casianders@yahoo.com
(812) 304-0054
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.
nature of Seller
Signature of Seller
4
Prin 'we of Se ler V
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Joyce L. Kruse
08/13/2026
08/13/2026
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — ID I L THAT APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it appe on nv yanc ent
Samuel Belt
Address (number and street)
Address (number and street)
2809 East State Road 168
4o
City, State, and ZIP Code
City, State, and ZIP Code 2oZ6'
Fort Branch, IN 47648
Country
Country G/BS,
USA
C
E-mail Address
Telephone Number
E-mail Address Tel phone Number
AVOj
sambeltnp21@gmail.com
(812) 781-8611
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?
❑ ❑ 4. Solar Energy Heating or Cooling System
❑ ❑X 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
❑ ®
for this residence? If yes, provide address:
❑ ❑X 6. Hydroelectric Power Device
❑ ❑X 7. Geothermal Energy Heating or Cooling Device
^ ✓ �a �O� V
Address (number and street)
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
inform ion, SSN/Dr' er's LkenseplOther Number is necessary only if a Homestead Deduction is being filed.)
Sig ure of Buy
Signature of Buyer 2/Spouse
ranted Legal a of B e 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Samuel Belt 08/13/2026
08/13/2026
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
SS 27485
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