HomeMy WebLinkAboutHomestead_Alvis (3)H. PREPARER 71
Preparer of the Sales Disclosure Form
Title
Pam Hancock
Closer
Company
LockyearTiUe, LLC
Email Address
parnela@lockyeartitle_com
Telephone Number
1 (812 ) 421-8405
Address (number and street, city, state, country, and ZIP Code)
20 NW 3rd ST, STE 840, Evansville, IN 47708
I. SELLERS)/GRANTOR(S)
as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
PELL
and street)
F
Address (number and street)
Cv �t aab 76Y
City, stae,anZIP Code
d.L
City, State, and ZIP Code
art; _r zoos
Count-
Country
Email Address
Telephone Number
Email Address
Telephone 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
equired by law, and is prepared in accordancewith IC 64.1-5.5. A person who knowingly and Intentionally falsifies thevalue of transferred
eal property, or omits or falsifies any information required to be provided, commits a Level 5 felony.
ignature of Seller ^
[Printed
Signature of Seller
N.. iie of Iler
Data igned (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mmldd/yyyy)
ARY ANN PELL
o��
J. BUYER(S)/GRANTEE(S) - APPLICATION FOR PROPERTY TAX DEDUCTIONS - I THAT APPLY
Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appearFlvLn, m
it
AARIN
VISAddress
(nber and street)
t
Address (number and street)
9178 W 350 S
City, State, and ZIP Code
City, state, and ZIP Code
Owensville, IN 47665
Country
EEmailddress
Tele hone Number
�
Email Address GIBBON COIIN
� II i.. ) umber
Pursuantto IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those thatapplyt
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
0 ❑
[21 ❑ 3. Homestead
residence?
❑ 0 4. Solar Energy Heating or Cooling System
❑ El5.Wind Power Device
,,/2 Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
❑ 21 6. Hydroelectric Power Device
❑ El 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
1 a _ l /a �� - 3�- � j�j , rj3Cj -�\
bestof
City, State, and ZIP Code County
Under penalties of perjury, I hereby certify that this Sales Disclosure, toCthhe 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/iD/Other Number is necessary only if a Homestead Deduction is being hied)
Signature of Buyer 1 ,
rJ q/i SIB
Signature of Buyer 2/Spouse
CtQAA I%V rt,1JA pl,�
Printed Legal Name of Buyer 1 SignDate (MMIDDAIY)
Printed Legal Name of Buyer 2/Spaise Sign Date (MMIDDNY)
AARIN ALVIS
Last 5 Digits of Buyer 1 SSNIDriver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID10ther Number
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