HomeMy WebLinkAboutHomestead_GreenbergK PREPARER
Preparer of the Sales Disclosure Form
Title
Milton Norman
Settlement A ent
Company
Email Address
Telephone Number
Hometown Title LLC
orders@hometowntitles.com
( 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 it appears on conveyance document
Seller 2 — Name as appea n c C m t
Carmen Hurley
Address (number and street)
Address (number and street) AUG C
Ii
5242 E 1300 5
U U
City, State, and ZIP Code
City, State, and ZIP Code
Haubstadt, IN 47639
Country
Country �j�
�t .
US
GIBSO� S4L7�i
Email Address
Telephone N ber
Email Address
a Number
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
al property, or omits or falsifies any information required to be provided, commits a Level 5 felony.
p4nature of Seller
Signature of Seller
nted ame of Seller I
Date Sig d ddl yyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Carmen Hurley :71(m
(+oJ� (1�11
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY ALL THAT APPLY
IL Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it appears on conveyance document
D ian Greenbern
Elouise Bromm
Address (number and street)
Address (number and street)
310 Julian Street
310 Julian Street
City, State, and ZIP Code
City, State, and ZIP Code
Elberfeld, IN 47613
Elberfeld, IN 47613
Country
Country
US
Us
Email Address
Telephone Number
Email Address
Telephone Number
dylan.greenberg2@aol.com
( 812 ) 618-8586
"1- Co' 1
I (61 g ) a0 (i— )"-Aa5j
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
❑ 1. Will this property be the buyer's primary
® O 3. Homestead
residence?
❑ ® 4. Solar Energy Heating or Cooling System
O ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
O IN
for this residence? If yes, provide address:
❑ (9 6, Hydroelectric Power Device
❑ ® 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
_a3 _ �� _ ioo m OZA . b C' C LI
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/Driver's License/1D/Other Number is necessary only if a Homestead Deduction is being filed.)
Signature of Buyer 1 —
Signature of Buye ,2/Spouse
=--?
Printed Legal Name of Buyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MMIDD/YY)
Dylan Greenberg D% y)
Elouise Bromm
Last 5 Digits of Buyer 1 SSNIDriver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
Sia
-711
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