HomeMy WebLinkAboutHomestead_DanielH.PREPARER
Preparer of the Sales Disclosure Form
Title
Kris Coon
Escrow Officer
Company
E-mail Address
Telephone Number
Regional Land Title
kris@regional-It.com
(812) 470-1300
Address (number and street, city, state, country, and ZIP Code)
4600 Washington Avenue, Suite 102, Evansville, IN 47714
I. SELLER(S)/GRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Brenda Miley
Address (number and street)
Address (number and street)
173 Hartin Drive
City, State, and ZIP Code
City, State, and ZIP Code
Evansville, Indiana 47711
Country
Country
USA
E-mail Address Telephone Number
E-mail Address
Telephone Number
(812) 385-6477
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.
Si na of Seller
Signature of Seller
Printed Name of 5 e Date Sign ,(mmldollvyyy) Printed Name of Seller Date Signed (mm/dd/yyyy)
Brenda Miley August 11
J. BUYER(S)j RANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDE!V " LL THAT APPLY
Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appears on o ve ante dom nent
Caleb Daniel
- a'
Address (number and street)
Address (number and street)
711 S Seminary Street
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, Indiana 47670
Country
Country
USA
E-mail Address
Telephone Number
E-mail Address UJILSSON COU
T*A * er
(812) 215-1173
Pursuant to IC &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
❑ 3. Homestead
Will this property be the buyer's primary
El
residence?
residence?
® 4. Solar Energy Heating or Cooling System
❑ 0 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ m 6. Hydroelectric Power Device
[� m 7. Geothermal Energy Heating or Cooling Device
A r nu er sl e
_
_ 1'1 �`7-y1�j3- ),,�`�rj-� g
Cityj%te,ZIPC.de,and pun
&%�t�
Under penalties of perjury,) 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 LkenseMlOther Number is necessary only if a Homestead Deduction Is being filed.)
Signs �e of yer
��
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Dpt OD/YY)
Caleb Daniel numb
Printed Legal Name of Buyer 21Spouse Sign Date (MM/DD/YY)
Last 5 Di its f Buyer 1 S N/Driver's License/lDlOtr
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/lD/Other Numuer
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