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Homestead_Fetscher
. H. PREPARER -Prepare(of the Sales Disclosure Form Title Arnie Masianka Settlement Agent Company E-mail address Address(number and street,city,state,country,and ZIP Code) 501 Main Street,Suite 101,Evansville,IN 47708 ~I. SELLER(S)IGRANTOR(S) Seller 1-Name as it appeats an conveyance document Seller 2-Name as appears on conveyance document Michael A.Potts Melanie A.Potts Address(number and street)_ f Address(number end street) /.^.. 1 /. -S t-�. (�2 5, �Llutu ` &- Iu-b Eb.% 3( s J ,% .� . ' r �-ck, tut. .ti,22. City,state,and ZIP Code y _ City.state,and ZIP Code r O!.<_i.1.:0- el-4ct% �t"�.�--U,bci r i.. l.i.ref-ci %!--1L,( '1, t4 1 e.v( :(,..J Country J Country US • US w 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. Signature e of Seller Signature of Seller/i"/;f l,�,lr J' _/�L,{` Z`' C...-;.1/2/ elSiy,-tom' k .l Printed Name`off Seller ( Dane signed(mrnldd/yyyy) Printed Namo of Salter Date signed(mmfdd/yyyy) Michael A.Potts 11/22/2021 Melanie A.Potts 11/22/2021 J. BUYER(S)IGRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY Buyer 1-Namo as It appears on conveyance document Buyer 2-Name as it appears on convo anco document( Robin Fetscher (': ure `t ` i-ie(-r Address(number and stree -- , ., Address(number and street) City,slate,and ZIP Code City,state,and ZIP Code o 1 I O't. r7v`Li iLle - -fs�'.Li -21 ail ; -- 7 Country L-1_-1i2 , Country LC:-lrL S- US US ( ) Pursuant to IC 6-1.1-12-44.the Sales Disc tosure Form may be used to apply for certain deductions.Identify all of those that apply: YES NO CONDITION YES NO CONDITION c) co 1.Will this property be the buyer's primary () 0 3.Homestead a Z ® 0 residence? 0 t 4. Solar Energy Heating or Cooling SA o O H © ® 2,Does the buyer have a homestead to be vacated 0 lXI 5.Wind Power Device for this residence? if yes,provide address: 0 (El 6.Hydroelectric Power Device N a a ril Address(number and street) 0 � 7.Geothermal Energy Heating or Coollr<tg ce O City,state.and ZIP Code County 26-11-31-300-004.692-021 A c7 Page 3