HomeMy WebLinkAboutHomestead_Memmer (2)H. PREPARER
Preparer of the Sales Disclosure Form
Title
Christa D. Tracey
Escrow Officer
Company
E-mail address
Telephone number
Southwestern Indiana Land Title
christa@swinland.com
(812) 425-0055
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLERS)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as it appears on conveyance document
David A. Dunn
Address (number and street)
Address (number and street)
2068 N Carithers Rd.
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Country
Country
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
(812) 779-7724
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6
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge an true, correct, and comp a as required
by law, and is prepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentionally ofAransferred real property, or
omits or falsifies any information required to be provided, commits a Level 5 felony.
Signatur�neller
Signature of Seller VO/TOE
Printed Name of Seller
Date Signed (mm/dd/
Printed Name of Seller Date Signed (mm/dd/yyyy)
David A. Dunn
yyyy) G
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY ALL THAT APPLY
Buyer 1 — Name as it appears on conveyance document
Buyer 2 — Name as it appears on conveyance document
Whittney Memmer
Michael R. Malone
Address (number and street)
Address (number and street)
1512 N Hurst Circle
1512 N Hurst Circle
City, State and ZIP Code
City, State and ZIP Code
Princeton, IN 47670
Princeton, IN 47670
Country
Country
United States of America
United States of America
Email Address
Telephone Number
Email Address
Telephone Number
1
(812) 677-7102
1
(812) 208-1212
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
0 ❑ . Will this property be the buyer's primary residence?
0 ❑ 3. Homestead
❑ 0 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for
this residence? If yes, provide address:
❑ 0 5. Wind Power Device
❑ 0 6. Hydroelectric Power Device
Address (number and street)
❑ 0 7. Geothermal Energy Heating or Cooling Device
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/Drivers
License/ID/Other Number is necessary if a Homestead Deduction is being filed.) I
ign ur yer 1
Sign ture f Buyer/2/Spouse
Printed Legal N e o Buyer 1 Sign Dad (MM/DD/y,Y)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DDNY)
Malone
Memm r `Michael
R.
fLa'stittney
5 Digits of B yer 1 SS river's Licen a/ID/Ot�e�NCmb
Last Bits o�er 2/Spouse SSN0IDr s License, Ot er Number
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