Homestead_Hill (24) H. PREPARER
Preparer of the Sales Disclosure Form Title ,.
KATHY MASTERSON CLOSING AGENT
Company
Address(number and street,city,state,country,and ZIP Code)
501 MAIN STREET, Evansville, IN 47708
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Wayne Timothy Harless
Address(number and street) Address(number and street)
609 N. Main St.
City,state,and ZIP Code City,state,and ZIP Code
PRINCETON, IN 47670
F USA Country
E-I Odd
Under penalties of perjury,I hereby certi 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.
�Signatur ( Signature of Seller
Pnn of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Way e Timothy Harless 01/20/2021
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 I
Timothy Hill Irish Hill
Address(number and street) Address(number and street)
315 L Street 315 L Street
City,state,and ZIP Code City,state,and ZIP Code
Chula Vista, IN 91911 Chula Vista, IN 91911
U A Country Coytrys
YES NO CONDITION YES NO CONDITION 0
a ❑ 1.Will this property be the buyer's primary 0 ❑ 3.Homestead co
re idence? a
❑ ❑✓ 4.Solar Energy Heating or Cooling System �
c,
❑ 2.Does the buyer have a homestead to be vacated ❑ ❑✓ 5.Wind Power Device H
for this residence?If yes,provide address: ❑ Q 6.Hydroelectric Power Device o o' tl
Ni Lru
Address(number and street) ❑ Q 7.Geothermal Energy Heating or Cooling ce"1 d
v
City,state,and ZIP Code County O .
26-12-07-102-002.697-028 XI
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