HomeMy WebLinkAboutHomestead_Hale (3)H.PREPARER
Preparer of the Sales Disclosure Form
Title
Milton Norman
Settlement Agent
Email Address
Telephone Number
Company
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
I. SELLER(S)IGRANTOR(S)
Seiler 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Ronald Scott Smith
Nancy Adalea Smith
Address (number and street)
Address (number and street)
3244 S 950 E
3244 S 950 E
City, State, and ZIP Code
City, State, and ZIP Code
Oakland City, IN 47660
Oakland City, IN 47660
Country
Country
us
us
Email Address
Telephone Number
Email Address
Te na Number
m.smithzone@yahoo.com
( 270 ) 282-1384
1
M ,e
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete as
IC 6-1.1-5.5. A who knowingly and intentionally falsifies the value of transferred
required by law, and is prepared In accordance with person
real property, or omi% or falsifies any information required to be provided, commits a Level 5 felony.
Signature of Seller J .1
Signature of Seller -�
Printed Name of Seiler ate Signed mm/dd/yyyy)
Printed Name of Selle Date Signed (mm/dd/yyyy)
Ronald Scott Smith (� -v
-7 a
Nancy Adalea Smith
IGRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS — la-N ALL THAT APPLY
as it appears on conveyance document
FMackenzie
Buyer 2 — Name �apo eyan ent
Hale
ress(numer and street)
Address (number and street)
t�C'
7068 N CR350 E
City, State, and ZIP Code Z026
City, State, and ZIP Code
Petersburg, IN 47567
Country
Country G/8SC�
NCO,,,,✓iY
us
Email Address
Telephone Number
�Emailddress A(iQ
R phone Number
Levi.hale92@gmail.com
( 812 ) 430-0434
)
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
® O 3. Homestead
® O residence?
O ® 4. Solar Energy Heating or Cooling System
O ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
O for this residence? If yes, provide address:
0 ® 6. Hydroelectric Power Device
O ® 7. Geothermal Energy Heating or Cooling 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
IC 6-1.1-5.5. A who knowingly and intentionally falsifies the value of
as required by law, and is prepared in accordance with person
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 LicenselID10ther Number is necessary only if a Homestead Deduction is being filed.)
Signature of Buyer 1
Signature of Buyer 2/Spouse
Printed Legal Name of Buyer 1 Si n Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Levi Mackenzie Hale �a'---
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
�9� 9 LO-5i- s C, s'.T -k—
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