Homestead_Himmelhaver H. PREPARER
Preparer of the Sales Disclosure Form Title
Lana HarperC10‘11/41 Ceike
Company
Address(number and street,city,state,country,and ZIP Code)
5231 Oak Grove Road,Suite A,Evansville,IN 47715
I,.SELLER{S}IGRANTOR(S) —
Seller 1—Name as it appears on conveyance document
Keith E.Baker Seller 2—Name as appears on conveyance document
Address(number and street)
12280 S 200 E Address(number and street)
City,state,and ZIP Code
Haubstadt,IN 47639 City,state,and ZIP Code
Country Country
United States of America United States of America
E-mail address
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,ort omits or falsifies any Information required to be provided,commits a Level 5 felony.
SiT.t .�Sellt Signature of Seller
Printed Name of Seller Date si na(mm/ddlyyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Keith E.Baker i
I^(S -
,34
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 appears on conveyance document
Matthew V.Himmelhaver Ashley K.Himmelhaver
Address(number and street) Address(number and street)
12280 S 200 E 12280 S 200 E
City,state,and ZIP Code City,state,and ZIP Code
Haubstadt,IN 47639 Haubstadt,IN 47639
Country Country
United States of America United States of America
E-mail address
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 �=--cn
esz,r
ID1.Will this property be the buyer's primary residence? ❑J3.Homestead cr H❑ tri 4.Solar Energy Heating or Cooling Syste@o H
❑ NI 2.Does the buyer have a homestead to be vacated for IDa 5.Wind Power Device ti o t�
this residence?If yes,provide address: ❑ L� 6.Hydroelectric Power Device n d
Address(number and street) 0 7.Geothermal Energy Heating or Cooling 3
O
1 te
City,state,and ZIP Code County 26-23-16-300-001.904-024 n
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