Homestead_Taborn H.-PREPARER.
Preparer of the Sales Disclosure Form Title
Lana Harper !
Company
Address(number and street,city,state,country,and ZIP Code)
5231 Oak Grove Road, Suite A,Evansville, IN 47715
L SELLER(S)IGRANTOR(S). .
Seller 1-Name as it appears on conveyance document Not o, j
Maurice L.Bolin Seller 2-Name(/l�n�� jconve c-,�(J/ C�,y�►,�
�1 umber and street) \S 7/X) ./4 Z J L / r3
(�j�"7 � f / /e Address(/nulmbtr afSd'�treetr /�
C'_/ ate,and ZIP Code I( J (, �� /� v •7(
' !�`„ f , /� y � City,state,and ode y
Country t��� r Country
United States of America United States of America
E-mail address
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•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,lew,: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.faisifies any Information required to be provided,commits a Level 5 felony. _
j Siq �J of Seller ✓% Signa re of Iler
...1)-e-- --Vi
� 02 f Da signed(mm/dd/yyyy)
Printed Name of Seller jj Da signie�(mm/ddlyyyy) Printed Name of Seller �`4- Is
I � � `
Maurice L.Bolin 1g ` `T- a + , I "t'
•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
Karissa A.Taborn
Address(number and street) Address(number and street)
5639 E.State Road 64
City,state,and ZIP Code City,state,and ZIP Code
Francisco, IN 47649
Country Country
United States of America United States of America
p
- — I
Pursuant.to:I.0 6=1.1-12-44,the Sales Disclosure Form maybe used to apply for certain deductions.Identify all of,those that apply: F
YES NO CONDITION , YES NO CONDITION zt.
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m
1/ N1' ❑ 3. Homestead o - -' H
1 ❑ 1.Will this property be the buyer's primary residence? ❑ l ' 4. Solar Energy Heating or Cooling Sys
N 6r
D �.Does the buyer have a homestead to be vacated for 0 �' S.Wind Power Device n
o
this residence?If yes, provide address: ❑ f 6. Hydroelectric Power Device o C
Address(number and street) u— El UI 7.Geothermal Energy Heating or CoolinTi vice
0City,state,and ZIP Code County 26-13-19-100-000.247-005 Co
..
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