Homestead_Roeder (2) 1 H PREPARER - -:
Preparer of the Sales Disclosure Form Title
Amy B. Pollard Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
7321 Eagle Crest Blvd., Suite A Evansville, IN 47715
I:SELLER($)%GRANTOR($)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Alex Hoefling Allison Nl cLr 'p�ic -tc
r15-_KIh A _
Address_(numberand-street)-ThAd numb.er_a d_street
City;it te;and ZIP Code �` 7 !City, e,a}d Zl _Code _ .S &LIS
Country Country
US US
. .
required by law,and is prepared'iri a ccorda nce with IC 6 1 1 5 5 A,person who know mdly:and mte'ntionally falsifies the value of tr nsferred_a '
'r'.eal property,or'omlts or-falsifies any infoimation;re uired to be rovided commits a Level 5 felony
S'Wnature of Seller 'gnat!,re f Seller, /
;Led Name o�fle Date signed(mm/dd/yyyy) Printed Name of Seller I at signed(mm/dd/yyyy)
Alex Hoefling 01/29/2021 Allison i� 9/2021
J' BUYER(S)IGRANTEE(S) -APPLICATION FOR P ROPERTY TAX DEDUCTIONS IDENTIFY ALL THAT APPLY
Buyer 1 —Name as it appears on conveyance document Buyer 2-Name as it appearrilc v: 'ancz•• AN
,
Lisa M. Roeder 0 _
Address(number and street) Address(number and street)
105 S. Main St.Apt. 1 -
City,state,and ZIP Code City,state,and ZIP Code FEB 3 2021
Fort Branch, IN 47648Co e
USuntry Country %y a �Y� �irtd
GIBBON CnUNT AUDITOR
. ,, ,_.
YES NO CONDITION YES NO CONDITION
✓❑ ❑ 1.Will this property be the buyer's primary 2 ❑ 3. Homestead
residence?
❑ Q 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated ❑ 0 5.Wind Power Device
for this residence? If yes, provide address: 0 ❑ y
6. H droelectric Power Device
Address(number and street) ❑ ❑ 7. Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
d6 1q 111 2 i1 ooi 32_2_ 096
3