HomeMy WebLinkAboutHomestead_SchmitsH. PREPARM
Premi-ar of the Sales DiscMsure Farm
Ccrt�rry
Address lnumber and street, city, slate, cwmry. and ZIP > tr I
?82G Crest $Ivd SuitE 241 E•ranwdle. IN 17715
Title
—�Enrl Address- r..:a� 1 r. IN• ram,
Telephone Nrmiber
{ 812 } 759-5555
Seiler 1 - tNWM as it appears on CMVf,}8nr� eocument se ler 2 -Name as appear-, 5 a-,corneyarlo5 ddcunrertE
Mansa S Rodger: `Drrrerly Pinown as Marisa R Queer inane m Ouesrl aim Dane Queen
Address trurriber and straelj ,tdtlresa (nur9tr3f end s6eei}
51i5 E 7?[I Sl i ltawina r, Dave
City, Spate, and ZIP Cede
City, State and ZIP Code
InditanapaBS N 1625rJ Prtl:seton, IN C7f�?�
Country
Country
IJS - US -- Telephone Number
- --
Email Address bane - ..
Te
- - 'Address P
hiumtser j Erraal6
r,1a=cSrrar+Sa9.�'�x!�ma°i •-�,m � 812 } r.p? 6728 ' d'2n5 Quo�r',3cci;•i:mafl rnrn { }z1' _ �-�1� 6284
r herota cartify Lhls Sates Disclosure. to the hest of my tame.ledge and W116f, is tsue, corrscb and complete ar+
Under par yt wv ai and
pm Y
,•eyrrrmed by I�i►, and is prepared t»a;.r:ardar►ce with tG ti•S.t-5-5- A persaxt who knowingly and irtterroltonagy feAVIOS tire+ralr,re of eanskined
rest profterty. or omits or Walfts any Infonrratlon raqulmd to be pf ovided. commits a Level 5 tetany.---
JrJe�yO1LSeller yFj/ fly sic a fll t ;ier _
gun SC , r, =d tVarnc of Se):e: Il3fe S. *tea r ,rnP;&Y:7Y'i
pnr•{ed Name e' Se41er Data S t y `r
rJansa r+ itY'gar5 1 •Ti. 202a i3ane k•1 Queen aKa Gene Guc.on
i 1OX9 2726
J. allYER(SYGi ME(S) — APKICATION FOR PRoPF-RTY TAX DEDUCTIONS.- IDEItiTIFY ALL THAT APPLY
Buyer t Name 8s it appears on oQnve�yanoE dncurrrent
i Buyer 2 - Name as it appe nt
d ', u r and s'rtt Astdress {rrurrber and sheet'
Gityr, State. and ZIP Code
-qlat- and 'IF Code
- ... OCT 1._ , 2026 -
t i>?i; R�ares - - Teleptwne Nunter e<rraii Address a epnq, Number
161
-- - - F -
Aursuent to lC 6-1.14244, the &ales bjsdasucs Foon may be used b aIrA;Y for ostta6n dedrtdtons ide+tt#r3f P1Y:
YES F!DYES No CONOFT" CflfltlfTlON
1. WiO floss property be the buyOfS OFMTY ;' ] 3. Homestead
® 0 residence? 4. Solar Enemy Pleating or Cooling System
---- --- t
_ i � � S. Wind Plower Device
❑ I 2- rr aes the buyer have a i�rnes ead to be vacated
for th-s reside;- e? g Yes. YrOvide sd � d ® B4 Hytlroeteclr9c Pamir Device
Address (nrmraerandsireeti - - - - ❑ ® 7. Czeotf*trnat Energy Hbagng[�nrQC'oolft Device
-GFly. state. and� a�Q - l a - � � 1a - cm
Under pfflnntties of PO4urY• I llwwbY tamely that this Sates i3isctosurrr, to the test of my krmwtedga aed betiet is MR6 COnvc t. snd 0=09b
as mquited by 13w, anti is prepared in accordariea wdih tC 64b5a. A pamon who knowingly and h*entiortalfy fallsHles tAsl vatus of
tiarrsfatrad Ipasi propeniy, or optits or faisibes any Info+mstion roquimd Io be provkhA commits a Lard 6 felony., �flloliw Both 1'y
uarm rmd + l oroP tY. ft Of W iw wa.n,r�a.. „s�e.e.vY uJY (t s Namore+wd L fr rfysn i� lsarn3f Rfad-} _
;�•raty & Suyer t Of 64rr : S;xatls3
cc� ( t hh,r��� t?8te ? egal Natm of Suyet 21SRartse 5ttin Date (lul rirTJi, t^!:
t� fG& '
-' ---- f ' -- i* - - SSh.:Qn,JE's LicensePl[}�C7ther POurn r
zsr 5 Digits .of Buyer i aS`ciiirtv�t'S t.icer„e3il7 dtt,er Nrmrber I i asi S G jrt f Buyer 15Pwse
{u c� - -
Page 3
H. PREPARER
[Preparer of the Sales Disclosure Form
Title
1`eah Brown —
SBIHement Agent_
Company
Email Address i Telephone Number
Regional Title Services LLC
closing s@reciionalMleIIccom ( 812 ) 759-5555
Address (number and street, city, state, country, and ZIP Code) �I
7820 Eagle Crest Blvd. Suite 201, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 — Name as it appears on conveyance document vySeller
2 — Name as appears on conveyance document r
Marisa R. Rodgers, formerly known as Marisa R. Queen
Dane M. Queen aka Dane Queen
Address (number and street)
Address (number and street)i
5405 E 77th St
304 Hawthorne Drive i
City, State, and ZIP Code
City, State, and ZiP Code
Indianapolis, IN 46250
Princeton, IN 47670 r
Country
Country
us
us `
Email Address
Telephone Number
Email Address
Telephone Number
rodgersmarisa93@gmail.com
( 812 ) 677-6728
dane.queen83 r@'�i gmail-Com
( 812 ) 779-6289
k Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and bellef, 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.
,Si
1/
Signature of Seiler
Printed Name of Seller Date Signed (mmldd/yyyy) Printed Name of Seller Date Signed (mm/dd/yyyy)
Marisa R. Rodgers 10/09/2026 Dane M. Queen aka Dane Queen 10/09/2026
f 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
Joseph M. Sr..hmits and Sandra K. Schinits as Trustees of the Joseph M
Address (number and street)
Address (number and street)
City, State, and ZIP Code--�
City. State, and ZIP Code —
Country
Country
us_
_
Email Address _ Telephone Number Email Address Telephone Number
( ) i ( )
---
Pursuant to IC 6-1.1-1244, the Sales Disclosure Form maybe used to apply for certain deductions. Identify all of those that apply:
—
YES NO CONDITION YES NO CONDITION
li{
® 0 1. Will this property be the buyer's primary ® O 3. Homestead
residence? O (9 4. Solar Energy Heating or Cooling System
0 ® 2. Does the buyer have a homestead to be vacated 0 ® S. Wind Power Device
for this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
Address (number and street) O ® 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 b.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, SSNiDriver's License/0/Other Number is necessary only if a Homestead Deduction is being filed.)
Signature of Buyer 1
Signature of Buyer 2/Spouse
I
! Printed Legal Name of Buyer 1 Sign Date (MMIDDIYY)
Printed Legal Name of Buyer 2/Spouse Sign Date (MWDO/YY)
Joseph M. Schmits, Trustee 10/9f2026
10/09/2026
I' Last 5 Digits of Buyer 1 SSN/Drivers LfcensellDlQther Number
Last a Diyils of Buyer 21Speuse SSN/[Driver's LicensellD101her Number
Page 3