HomeMy WebLinkAboutHomestead_Conner (2)H.PREPARER
Preparer of the Sales Disclosure Form Title
Leah Brown Settlement Agent
Email Address Telephone Number
Company ( 812 ) 759-5555
closings@ regionaltitlellc.com
Regional Title Services LLC
Address (number and street, city, state, country, and ZIP Code)
7820 Eagle Crest Blvd, Suite 201, Evansville, IN 47715
I. SELLERS)/GRANTOR(S) _
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Zane Keith Anderson
Address (number and street)
Address (number and street)
8066 S 25 W
City, State, and ZIP Code
City, State, and ZIP Code
Fort Branch, IN 47648
Country
Country
us
Email Address
I
Telephone Number
Email Address
1
Telephone Number i
( ) l
MA
( 812 ) 622-0923
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 r falsifies any information required to be provided, commits a Level 5 felony,
Sin lure of�Iler
Signature of Seller
�� "
Pri t d Name of Seller
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/ddlyyyy)
Z ne Keith Anderson
10/02/2026
10/02/2026
j
J. BUYER(S)/GRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTIFY ALL THAT APPLY
L1 — Name as it appears on conveyance document
Buyer 2 —Name as it appears on conveyance document
C. Conner
Address (number and street)
Address (number and street)
300 E Sinclair St Apartment 13
City, Slate, and ZIP Code
City, State, and ZIP Code i
Fort Branch, IN 47648
Country
Country
us
Email Address Telephone Number
Email Address
Telephone Number
( )
brianconner84@hotmail.com ( 812 ) 632-0364
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
IN O 3. Homestead
® D residence?
O ® 4. Solar Energy Heating or Cooling System
O ® 5. Wind Power Device
Does the buyer have a homestead to be vacated
this residence? If yes, provide address:
p ® 6. Hydroelectric Power Device
` O ® 7. Geothermal Energy Heating or Cooling Device
j Z/ pZr®�+b�
and street)
E
IPCode County
Under penalties of perjury, I hereby certify that this Sates 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 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
fnforinatian, SSNIDriver's License/ID/Other Number is necessary only if a Homestead Deduction is being filed.)
4 Sigrl@ture of Buyer 1
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Sign Date (MMIDD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Brian C. Conner 10/2/2026
Last 5 Digits of Bu r 1 S r License/ID/Other Number
10/02/2026
'Last 5 Digits of Buyer 2/Spouse SSN/Drivers License/iD/Other Number
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