HomeMy WebLinkAboutHomestead_LanderH.PREPARER
Preparer of the Sales Disclosure Form
Title
Company - I . ,, Email Address I Telephone Number
1 ae��cT+ o+ ,, ++ion ( 812 ) 461-6399
Address (number and street, city, state, country, and ZIP Code)
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
I. SELLERS)/GRANTOR(S)
Seller 1 - Name as ft appears on conveyance document
Seller 2 - Name as appears on conveyance document
Breanna M. Poole
Kaden M. Steinhart
Address (number and street)
Address (number and street)
401 N Hull St
401 N Hull St
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648
Fort Branch, IN 47648
Country
Country
US
us
Em ' dress Telephone Number Email Address Telephone Number
I'VWwI1,00, ow- ) %ui llo
Under penalties of perju , I hAreby certify this Sales Disclosure, to the best of my knowledge andhAief, 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.
Signature of Seller Signature
a
Prints a e of Belle i ��//( Printed Namd:W Seller Date S ned ( d yyy)
Breanna M. Poole Cjr#��/yyyy)
(j 0 Kaden M. Steinhart Q`
J. BUYER(S)/GRANTEE(S) - APPLICATI N FO PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT PPLY
Buyer 1- Name as it appears on conveyance document Buyer 2 - Name as it appears on cornce document
Address (number and street)
Address (number and street) j Blk
�J
6042 Laurel Tri
City, State, and ZIP Code
City, State, and ZIP Code
Henderson, KY 42420
Aug
Country
Country
us
Email Address Telephone Number
i�CL� u r �\ �1� mof(, Cr* ( 270 ) 831-0810
Email Address
GI
Teleph a Number
Pursuant to IC 6-1.1A244, the Sales Disclosure Form maybe used to apply for certain deductlons. Identify al o shf
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
® 0 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 or Cooling Device
Address (number and street)
n -'z - _ � - g� ) - ��
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
information, SSN/DHver's LicenselID/Other Number is necessary only if a Homestead Deduction is being filed.)
3Sig atu of B er 1 fv Pqla(e
U
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Dat (MM/ D/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DDNY)
Austin Lander
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
j -� 7011
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