Homestead_Kiesel H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers 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
Jeffrey D. Hall Deborah A. Hall
Address(number and street) Address(number and street)
701 E. Oak Street 701 E. Oak Street
City, State and ZIP Code City,State and ZIP Code
Fort Branch, IN 47648 Fort Branch, IN 47648
Country Country
United States of America United States of America
E-mail address
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.
Mof$fillerrit Si�nature of Seller 7 //
arne Name of Seller Date signed(mm/dd/yyyy) P inted Name of Seller i Date signed(mm/dd/yyyy)
Jeffrey D. Hall 12/10/2021 Deborah A. Hall 12/10/2021
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
James Kiesel Cynthia Fields
Address(number and street) Address(number and street)
4237 Wayne Road 4237 Wayne Road
City, State and ZIP Code City, State and ZIP Code
Fruitland Park,FL 34731 Fruitland Park, FL 34731
Country Country
United States of America United States of America
E-mail address
apply for certain deductions.Identify all of those that apply:
YV. NO CONDITION YES NO CONDITION
El . Will this property be the buyer's primary residence? 0 3. Homestead .F
0 El 4. Solar Energy Heating or Cooling Sy — X
0 2. Does the buyer have a homestead to be vacated for this 0 El 5. Wind Power Device
u `�
residence? If yes,provide address:
0 El 6. Hydroelectric Power Device "
Address(number and street) ❑ RI 7. Geothermal Energy Heating or Goo ing D vice ,..y
V_
City, State,and ZIP Code County ¢_ I �
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