Homestead_Williams H. PREPARER
Prepare'of the Sales Disclosure Form I Title
Gwyn Shaw , Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
U 5231 Oak Grove Road,Suite A,Evansville,IN 47715
1: SELLER(S)/GRANTOR(S)
,, Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Robert D.Houchins ( Andrea J.Houchins
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°- Address(number and street) Address(number and street)
10097 S Partridge Ave. 10097 S Partridge Ave.
4' City,state,and ZIP Code
o 4 Haubstadt,IN 47639 I City,state,end Code
Haubstadt,IN 47639
ac,, Country Country
>a United States of America United States of America
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v Under penalties of perjury, I hereby certify this Sales Disclosure,to the best.of my knowledge and'belief,is true, correct and complete as
:o required bylaw,and Is prepared In accordance with IC 6-1.1.5.5.A person who knowingly and Intentionally falsities the value of transferred
a, real-grope ,or omits or falsifies any Information required to be provided,commits a Level 5 felony.
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Si, l Sig lure of Sett2 n
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Printed Name of Seller Date signed(mm/d ) Printed Name of Seller Dat signed ilmml
Robert D.Houchins �l /, / f Andrea J.Houchins // f�-y i)a I
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�i`o J.BUYER(S)/GRANTEE(S)—APPLICATION FO ROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APFaLY
4- Buyer 1-Name as it appears on conveyance document
Buyer 2-Name as appears on conveyance document
c Robynn Williams
a, Address(number and street) Address(number and street)
700 E.Ulen St
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City,state,and ZIP Code City,state,and ZIP Code
a Fort Branch,IN 47648
-' Country Country
= United States of America United States of America
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c E-mail address
Pursuint 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.)
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YES NO CONDITION YES NO CONDITION
3 Ea 0 3.Homestead v txj
Ea 0 1.Will this property be the buyers primary residence?
0 El 4.Solar Energy Heating or Cooling S coH
2.Does the buyer have a homestead to be vacated for 0 Ed 5.Wind Power Device z Iv r
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z this residence? If yes, provide address: 0 m 6.Hydroelectric Power Device n N.)
o Address(number and street) l t 0 WI7.Geothermal Energy Heating or Cool 'ce a
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City,state,and ZIP Cod County • 26-19-18-302-000.900-026 x,
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