Homestead_Sweeney H. PREPARER
Preparer of the Sates Disclosure Form Title
Amanda Daly Settlement Agent
Company
Address(number and street,city,state,country.and ZIP Code)
r 7820 Eagle Crest Blvd,Suite 201,Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conve ,ent
Steve Alan robes
,_._
Address(number and street) Address(number and street) `!
6358 N State Road 65
).,,46
City,state,and ZIP Code City,state,and ZIP Code "s .i�
Hazleton,IN 47640 'PO
OC el,?0
Country, Country OGc 4",
US tip`.
of my knowledge and belief,is true,correct and complete as 1
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. Information required to be provided,commits a Level 5 felony.
Signature of elle /yam Signature of Seller
" Printed`Name of Seller Date signed(mm/ddiyyyy) Printed Name of Seller Date signed(mm/ddiyyyy)
Steve Alan Jones 02/10/2022 02/10/2022
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
Gary Brent Sweeney Regina Ann Sweeney
Address(number and street) Address(number and street)
1712S133rdSt 1712S133rdSt
City,state,and ZIP Code City,state,and ZIP Code
Omaha,NE 68144 Omaha,NE 68144
Country Country
US US
O 1.Will this property be the buyer's primary 0 3.Homesteadl
`�✓ residence? (� l 4.Solar Energy Heating or Coaling System
t 2.Does the buyer have a homestead to be vacated 0 N 5.Wind Power Device
Q for this residence? If yes, provide address: p ® 6.Hydroelectric Power Device
Address(number and street) p IN 7,Geothermal Energy Heating or Cooling Device
City,state.and ZIP Code Count „- Q Q0' .
y___.. _ -perjury,1 hereby certify that this Sales Disclosure,to _
Under penalties ofthe 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