Homestead_Neidigh H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Latham Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
14600 Washington Ave,Suit 102 Evansville,IN 47714 ,
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance docu
Michael A.Lewis Robynn A.Williams
Address(number and street) Address(number and street)
SCte ce. "t(YTh , 1 A kR. r,,‘ .
City,state,and ZIP Code City,state,and ZIP Code
-k- - re),_(\(" h.� --hi T. -A 4-1( 0
Country Country
E-mail address
(W) to - ulna
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.
Signature of Seller S" lure of Seller • -
r�f#1 � ---- C
Printed ame of Sell _,� Date i Printed Name Seller Date signed(mrNdd/yyyy)
Michael A.Lewis /2.kedzI Robynn A.Williams 1 a1:-11,-1)-a 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
Heather Dawn Neidigh
A-dress(nu' •-r .rid treat) Address(number and street)
s + and ZIP Code City,state,and ZIP Code
Country Country
E-mail address
apply for certain deductions.identify all of those that apply:
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co YES NO CONDITION YES NO CONDITION w
3. Homestead CO
o ' 1.Will this property be the buyer's primary ,r c
(� tzl
residence? 0 x 4. Solar Energy Heating or Cooling Sys8 H
rn o
2.Does the buyer have a homestead to be vacated 0 x 5-Wind Power Device N
0
for this residence? If yes, provide address: p x 6. Hydroelectric Power Device < 2 a
_i Address(numb nd street) 0 x 7. Geothermal Energy Heating or Cooli9 ice
`i. 4�( state,and ZIP Code County 26 18 13-402-000.228-026 0
oy / L kp -70 ,r? '4il-� °)
' Under penalties of perjury,I ereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
eN-1 '
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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