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Homestead_Hackworth (2) H. PREPARER Preparer of the Sales Disclosure Form Title Stacey Salzman Settlement Agent -- , Company Address(number and street,city,stale,country,and ZiP Code) 2301 N.Burkhardt Road,Evansville,IN 47715 I. SELLERS)/GRANTOR(S) - Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document Toby D.Krieg Amy L.Krieg Address(number and street) Address(number and street) 311 W.Maple St. 311 W.Maple St. City,state.and ZIP Code City.state.and ZIP Code Haubstadt,IN 47639 Haubstadt,iN 47639 Country Country US US E-mail address address required by law,and Is prepared in accordance with IC 6-1.1.5.5.A person who owingiy and I onatty falsifies the value of transferred real property,or omits or falsifies any information required to be provided,co m is a Leve 5 fel y. Signature of tier S n urebf Seller Printed Name r Date-igned(mm/ddlyyyy) Print armo S er Date signed(mmldd/yyyy) Toby D.Krieg j 08/2022 Amy L. rieg 02/08/2022 J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DE TIONS-IDENTIFY ALL THAT APPLY Buyer 1-Name as it appears an conveyance document Buyer 2-Name as it appears on conveyance document Joseph Q.Hackworth Lt D Address(number and street) Address(number and street) F I L J 307 E.Parker St. City,state.and ZIP Code City.state,and ZIP Code FEB ,2 52022 Pinckneyville,IL 62274 Country Country e _ US J// _ ��-. .�i'l/���r� .c✓ E-mail address . for certain deductions.Identify all of those that apply: YES NO CONDITION YES NO CONDITION 031 O 1.Will this property be the buyer's primary (i 0 3.Homestead residence? D c 4.Solar Energy Heating or Cooling System O O 2.Does the buyer have a homestead to be vacated 0 t 5.Wind Power Device for this residence?If yes,provide address: © GO 6.Hydroelectric Power Device Address(number and street) 0 IA 7.Geothermal Energy Heating or Cooling Device City,state,ZIP code,and county 24'\ ^ 36 .*' (9 r 0M.o-,. '(]-Q V Q - d0(? 3 of 5