HomeMy WebLinkAboutHomestead_KernsH.PREPARER
Preparer of the Sales Disclosure Form
Title
Allyn Tresenriter
Escrow Officer
Company
Foreman Watson Land Title
Email Address
ATRESENRITER@FW-LT.COM
Telephone Number
(812 ) 909-4543
Address (number and street, city, state, country, and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I. SELLER(S)IGRANTOR(S)
Seller 1— Name as it appears on conveyance document
Sollor 2— Name as appears on conveyance document
ADJ Real Estate Investments LLC
Address (number and street)
Address (number and street)
702 East Park Street
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch IN 47648
Country
Country
USA
USA
Email Address
Telephone Number
1(618
Email Address
Telephone Number
Ajmayberryr@yahoo.com
) 263-7789
( )
Under penalties of perjury, I hereby certify this Sates Disclosure, to the best of my knowledge and belief, Is true, correct, and complete as
required by taw, and Is prepared In accordance with IC 8-1.1-fi.6. A person who knowingly and Intentionally falsities the value of transferred
real property, or omits or falsifies any Information required to be provided, commits a Level 6 felony.
ignoturo f ter �J
' /
Signature of Sailor
to atria of 5 Iler Date Signed (mmidd/yyyy) Printed Name of Seller Date Signed (mnVddJyyyy}
Arrion Mayberry, Member 08/07/2026
J. BUYER(S)IGRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS -- IDENTIFY ALL THAT APPLY .
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it eppoars on voyance document
Rylee Andrew Kerns
Address (number and stroot)
Addross (number and street)
103 South Church Street
City, State, Arid ZIP Code
City, State, and ZIP Code
4011-1
Owensville IN 47665
Country
Country
02Email
USA
USA
Addross
e)
Email Address SUM CO Q Tateph Number
( )
rylee.kemsi"a7me.com
(812 $$ 84- 931
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to
apply for certain deductions. Iden ,�+ ose that apply:
YES NO CONDITION
YES NO CONDITION TOR
1. WIII this property be the buyer's Primary
❑ [� 3. Homestead
d ❑ residence?
❑ 0 4. Solar Energy Heating or Cooling System
❑ El 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
❑ ® for this residence? If yes, Provide address:
❑ Q 6. Hydroelectric Power Device
❑ Q 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, and ZIP Code County
Under penalties of perjury, t hereby certify that this Sales Disclosure, to the best of my knowledge and belief, Is true, correct, and complete
of
as required by law, and Is prepared In accordance with IC 6-1.1-6.6. A person who knowingly and Intentionally falsifies the h su ouse's
transferred real property, or omits or falsifies any. Information required to be provided, commits a Level 6 felony. (Nolo:A
lnformatlon, SSN/DrJver's License/1m/otherNumberls necessary only War Homestead Deduction is being filed.)
S na of Buyo 1
Signature of Buyer 2/Spouse
"-M 1'4 1WC. W //
i 1
ted Legal Name of Buyer 1 Sign Date (MWL)DIYY)
Printed Le()al Name of Buyor 2JSpouse Sign Date (MWDDIYY)
Rylee Andrew Kerns 08/07/2026
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Lost 5 Digits of k3tryer 2/Spouse SSN/Drivor s Licenso/il]lOthor Number
Last 5 of SSN: 76077
1 Last 5 of SSN:
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