HomeMy WebLinkAboutHomestead_StraubH. PREPARER
Preparer of the Sales Disclosure Form
Title
Wilchela ConnolIV Dircks
Settlement Agent
Company
Email Address
Telephone Number
Regional Title Services LLC
closings@regionaltitlellc.com
( 812 ) 759-5555
Address (number and street, city, state, country, and ZIP Code)
7820 Eagle Crest Blvd, Suite 201, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Sherri L. Smith
Rhonda G. Moore
Address (number and street)
Address (number and street)
526 S Eighth Ave
526 S Eighth Ave
City, State, and ZIP Code
City, State, and ZIP Code
Haubstadt, IN 47639
Haubstadt, IN 47639
Country
Country
us
US
Email Address '1
Telephone Number
Email Address Telephone Number
( 812 ) 215-1319
rgmoore@usi-edu ( 812 ) 568-8817
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 roperty, or omits or falsifies any information required to be provided, commits a Level 5 felony.
Sig t e of Selle
r
Sioily
+
j;O4�
Print d Name of Seller
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/ddlyyyy
Sherri L. Smith
08/11/2026
Rhonda G. Moore
08/11/2026
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY l
Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appears on cI ocument
Angela L. Straub
Address (number and street)
Address (number and street) JL
272 S Cale St
City, State, and ZIP Code
City, State, and ZIP Code
AUG Z
Poseyville, IN 47633
Country
Country
us
Email Address
Telephone Number
Email Address
elep one Number
angie7327@gmail.com
('b`- ) 7fe-
GI8$0
Pursuant to IC 6-1.1-12.44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
® O 3. Homestead
®
residence?
0 ® 4. Solar Energy Heating or Cooling System
0 ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
0 ®
for this residence? If yes, provide address:
0 ® 6. Hydroelectric Power Device
0 ® 7. Geothermal Energy Heating Device
Address (number and street)
portCooling
�� _ 3 _ - Cy-) - CA- , Cj 1 U - 001�
City, State, and ZIP Code 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
fo inrnatla , 5SN/Drivees Li ns91)g1cat er Number is necessary only if a Homestead Deduction is being tiled.)
Sig alure, f Buyer 1 '
Signature of Buyer 2/Spouse
e of Buyer 1 Sign Date (MM/DD/YY)
Nrtt€d Legal wrn
Printed Legal Name of Buyer 2iSpouse Sign Date (MM/DDNY)
Angela L. Straub 8/11/2026
08/11/2026
Last 5 Digits of Buye 1 SaRe"s License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
Page 3
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H. PREPARER
Preparer of the Sales Disclosure Form
Title
Leah Brown
Closer
Company
E-mail address
Telephone number
Regional Title Services, LLC
ClosingS Re ionalTitlellc.com
(872 ) 812-759-5555
Address (number and street, city, state, country, and ZIP Code)
7820 Eagle Crest Blvd., Suite 201 - Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
NancyR. Harti
Address (number and street)
Address (number and street)
526 S Eighth Ave
526 S Eighth Ave
City, state, and ZIP Code
City, state, and ZIP Code
Haubstadt, IN 47639
Haubstadt, IN 47639
Country
Country
us
us
E-mail address
tle o�ber
E-mail address
{ phone number
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, c rrect 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 orfalsifies any information required to be provided, commits a Level 5 felony.
Signat re of Seller
Signature of Seller
"hied Naof Sel r
to ig ed ( mldd/yy
Printed Name o eller Date signed (mm/dd/yyyyW)
i 1
I
CC 1'] L� r
A
J. BuYER(5)/GRANTEE(S) -APPLICATION FO PROPERTY TAX DE-11311 CTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 Name ap acs c ve ancetocumeni
as it appears on conveyance document
nit
4
Addre$s�u er d stjee�t +
FBuyerame
umberand street)
��.. (City,7ft,FqVM
and ZI' ' L r �(� /
r\/-r ((�
and ZIP Code
Country r
J
Country
E-mail ddr s
(-G�►�I
Telephone number
E-mail address
Telephone number
1t77 `u
(1610 7s� ��C
( )
p6rivant to IC 6-hi- 2.44, the Sales Disclosure Forth may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
0 ❑ 3. Homestead
1. Will this property be the buyer's primary
residence?
❑ E] 4. Solar Energy Heating or Cooling System
❑ 0 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
❑ 0
for this residence? if yes, provide address:
❑ 0 6. Hydroelectric Power Device
❑ (] 7. Geothermal Energy Heating or Cooling Device
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 Lion, SSM/D '- ees Lice a D/Ather Nurrther is necessary if a Homestead Deduction is being filed)
Si+gnat
e o Buyer 1 ! --"- ear%
Signature of Buyer 2/Spouse
`Printed Legal Sign Date ( M/D
f lfl
1YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Last 5 Digits of Buyer i SS Criv_ers L cqpse/IDIOther Num er
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
Last 5 of SSN: 015
Last 5 of SSN
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