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Homestead_Mallory (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Christa D. Gibbs Escrow Officer
Company
Address(number and street,city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
Amy Mutz
Address(number and street) Address(number and street)
500 E. Plum Street
City,State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 ,
Country Country
United States of America
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 roperty,or omits or falsifies any information required to be provided, commits a Level 5 felony.
(Signature of Seller i"--
4-... - Signature of Seller
Printed Name of Sell Date signed(mm/qd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Amy Mutz i11-7- 1
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
Tori D. Mallory
Address(number and street) Address(number and street)
310 3rd Avenue
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 ,
Country Country
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:
W re. NO CONDITION YES/ O
NO CONDITION x
0 1. Will this property be the buyer's primary residence? r 3. Homestead F12
0 M C•J
Le 4. Solar Energy Heating or Coolin
0 01,(Does the buyer have a homestead to be vacated for .,...
2 a.
o V5. Wind Power Device
this residence? If yes, provide address:
0 IV Hydroelectric Power Device -cri c.,.„•;-
Address(number and street) 0
7. Geothermal Energy Heating or Otosiiil Deve
:.-.
....
(=>
City,State,and ZIP Code County
06 23'06-/QC'Den/39- V_ ICP efi
t
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belier, is true, correct
,
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