HomeMy WebLinkAboutHomestead_Smith (7)H.PREPARER
Preparer of the Sales Disclosure Form
Title
Milton Norman
SettlementAgent
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
1, SELLER(S)IGRANTOR(S)
Seller 1 - Name as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Bradley S. Black
Stephanie L. Black
Address (number and street)
Address (number and street)
121 N Embree St
121 N Embree St
City, State, and ZIP Code —�� _
City, State, and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
--_--
Country
Country_.
US
us
Email Address
Telephone Number
Email Address
Telephone Number
7;;'
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.
ign of Seller
Signature of Seller_
f �-f
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Bradley S. Black
Stephanie L. Black
on7 - eo
J. BUYER(S)IGRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS - IDENTIFY AL TH A PLY
= Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appea o eyan oc lit
Brandon Cole Smith_
Address (number and street)
Address (number and street) as
1008 S Seminary St
City, State, and ZIP Code
City, State, and ZIP Code
Princeton, IN 47670
Country
Country �/ a p��OF4
Pv
US
US
Email Address Telephone Number Email Address N ephone Number
O
brandonsmith21210@yahoo.com ( 812 ) 215-9620 6'a5 I (
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
IN D 1. Will this property be the buyer's primary
® O 3. Homestead
residence?
Q (N 4. Solar Energy Heating or Cooling System
0 IN S. Wind Power Device
® 2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
p 00 6. Hydroelectric Power Device
0 ® 7. Geothermal Energy Heating or Coaling Device
Address (number and street)
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 L kensO&OtherNumberis necessary only if Homestead Deduction is being filed.)
Signature of Buyer 1
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Dat
(M DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Brandon Cole Smith
�-3
Last 5 Digits of Buyer 1 SSN/Drivers License/ID/Other Number
Last 5 Digits of Buyer 2JSpouse SSN/Drivers License/ID/Other Number
3-11 ci
Page 3