Homestead_Hose H. PREPARER
Preparer of the Sales Disclosure Form Title
Timothy Shea Processomg Coordinator
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd Ste 201,Evansville,IN 47715
I. SELLER(S)/GRANTOR(S) _
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Kevin R.Miley Tamara K.Miley
Address(number and street) Address(number and street)
825 N West Drive 825 N West Drive
City,state,and ZIP Code City,state,and ZIP Code
Oakland City,IN 47660 Oakland City,IN 47660
Country Country
E-mail address
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 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 lure of Seller04 Sig t re of Seller I i
.Qi(��. r
Prin ed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller D to sinne,1( m/dd/yyyy)
Kevin R.Miley I. 31,( I 7.--1 Tamara K.Miley t 11)
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
David Nathanael Hose Heather Nicole Hose
Address(number and street) Address(number and street)
' 1 t . S•SanArk AVe, -SeAtA/L"
City.stale.and 7IP Cnde . N
4iO
City, te,and ZIP Code
Country Country
E-mail address '
apply for certain deductions.Identify all of those that apply:
a.
YES NO CONDITION YES NO CONDITION W
1.Will this property be the buyer's primary '1 g p
0 3.Homestead oK 17residence? 4.Solar Energy Heating or Cooling System o - -9
o r. 2.Does the buyer have a homestead to be vacated 0 ,E( 5.Wind Power Device c N t
g )gii 0 for this residence? If yes, provide address: p JD' 6.Hydroelectric Power Device D
M Address.number and street) p . 1' 7.Geothermal Energy Heating or Cooling De_ t _, t
cNi 1. t g 8 St&AA4 f
p-Cit tat ,and I .Code County xr
o J ILtJ
�� ��/l„I^i 1 .. 26-14-18-102-001.008-007 CO
I
Page 3