HomeMy WebLinkAboutHomestead_PetersonH.PREPARER
Preparer of the Sales Disclosure Form
Title
Leah Brown
Settlement Agent
Company
Email Address
Telephone Number
i Regional Title Services LLC
closings@regionaltitlellc.com
( 812 ) 759-5555
Address (number and street, city, state, country, and ZIP Code) t
7820 Eagle Crest Blvd, Suite 201, Evansville, IN 47715 1
—
I. SELLER(S)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document
Seller 2 — Name as appears on conveyance document
Premium Home Rentals LLC
I
Address (number and street)
Address (number and street) i
3525 Wayland Drive
City, State, and ZIP Code
City, State, and ZIP Code
Evansville, IN 47725
Country
Country
us
Email Address
Telephone Number
Email Address
1
Telephone Number
premiumhomerentals25@gmail.com
( 812 ) 306-1348
( )
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 la ,and is prepared in accordance with IC 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of transferred
r pro , of omits or Pals' s any information required to be provided, commits a Level 5 felony.
Signat re o S er
Signature of Seller j
Ij
1/Pr (ed Narneyof Seller
Date Signed (mm/dd/yyyy)
Printed Name of Seller
Date Signed (mm/ddlyyyy)
avid Smith, Member
10109/2026
10l09/2026
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 appea
c
Alex J. Peterson
Address (number and street)
Address (number and street) `I
2113 Aurora Drive
I
City, State, and ZIP Code
City, State, and ZIP Code OCT 13 2026
Evansville, IN 47720
Country
Country
u5
LA
Email Address
Telephone Number
Email Address
tuber
J alexjpeterson003@gmaii.com
( 812 ) 706-9683
GIBSON COUNTY
AUDIT)OR i
Pursuant to IC 64.1-12-44, the Sales Disclosure Form maybe 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
0 ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
O ®
for this residence? If yes, provide address:
O ® 6. Hydroelectric Power Device
O ® 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
�1 ,. _ 1LI— 100` j^i U�r OC)0, k--)rxrl' M11
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, SSA/Driver's LkenseliD/Other Number is necessary only if a Homestead Deduction is being filed.)
Signatur of Buyer 1
Signature of Buyer 2/Spouse
Printed Legapfame of uyer 1 Sign Date (MM/DD/YY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY)
Alex J. Peterson 10/9/2026
10/09/2026
Last 5 Digits of Buyer 1 SSN/Drivers License/IDlOther Number
Last 5 Digits of Buyer 2/Spouse SSN/Dover's License/ID/Other Number
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