Homestead_Madison (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Gourley Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave, Suite 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 document
Charles W. Sandefur, III Melody D. Sandefur
Address(number nd street) 'Andress(number and street)
r !3..7.3 c�....,7 -`is V'r`O i`r urs
City,state,and Z Code � � ty,state,and ZIP Code
Country
C°T tsa ,
E-mail addre Telephone number
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 fe ny. r -
�S' nature of Seller S' ature of f& r (A c.
Printed Name of Seller Date signed(mm/dd/yyyy) Printed me of Se Date ned(rnm/dd YYYy)
Charles W. Sandefur, Ill `!//' ' 'Z,, Melody . San fur
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
Caden Madison
�/�/ (n{ �Sabryn Alstatt I.
Address( mber ann `( �,Y 1�-� d`ddress(number and street) Pp 1 Z 7
City,state and ZIP e it state.and ZIP Code
Country County 5 n
E-mai des Telephone number
Pursuant t 6-1.1-12-44,the Sales Disclosure Form may be used to apply for b4rt deductions.tddirftlfy all of those that apply:
YES O CONDITION YES O CONDITION
1.Will this propel by i uy- j;n 0 3. Homestead
0 residence? 0 O 4. Solar Energy Heating or Cooling System
Does the buyer = • • cated a CI 5.Wind Power Device
or this residence?If fee[I:ar�v�sQ, r?ress: 0 0 6.Hydroelectric Power Device
Address(number and street) FEB 1 8 2022 o CI 7.Geothermal Energy Heating or Cooling Device
4,4" ', vh
City,state,ZIP code,and county GI - (l4 ,y�q' ,1 C 0
N COUNTY AUDITOR 6r -`4^?-'�i0-0 Z CI + '3'
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
ared in accordance with IC 6-1.1-5.5.A person who knowingly and lly falsifies the value of
transferred° r falsifies any informationrequ lony.(Note:Both spouse's
fnformation, D�erty,or omits •n •