Homestead_Masters (2) •
H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Latham Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave,Suit 102 Evansville,IN 47714
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance docu
Jeffery Alan Williams
Address(number and street) Address(number and street)
7/l1 OCD SM-e RP.
City,state,and ZIP Code City,state,and ZIP Code
ti14I'oi c),tc/� N, `/' .'V to
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.
Signatu i /of Seller _deSignature of Seller
Printed Name of SellerSeller Date Printed Name of Seller Date signed(mm/dd/yyyy)
Jeffery Alan Williams /2 - Zi
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
Timothy Masters
Ad ress(number and street) Address(number and street)
.=1C?6 C O- /�'�G�.�) '! S�
,G tate.and ZIP Code City,state,and ZIP Code
Country Country
E-mail a dress E-mail address Telephone number
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:
YES NO CONDITION Homestead YES NO CONDITION E6
I1.Will this property be the buyer's primary O 3. 0
-' residence? 0 x 4. Solar Energy Heating or Cooling Sy0i2. Does the buyer have a homestead to be vacated 0 x 5.Wind Power Device o
0for this residence?If yes,provide address: p x 6. Hydroelectric Power Device tri
leyAddress(number and street) 0 x 7.Geothermal Energy Heating or Coolice Ci
City,state,and ZIP Code County
26-12-07-303-004.176-028 c)
co
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number