Homestead_Cox (5) H. PREPARER
PreparTitle
of the Sales DisciosgTe Form Escrow Officer
Micah scab Scott -
Foreman Watson Land Title
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd. Evansville, IN 47715
I. SELLER(S)/GRANTOR(S) appears on conveyance document
Sellerh 1—Name M.
Seller 2—Name as it appears on conveyance document Cerny N. Davis (f/k/a Gamy N.Weber)
Christopher DaviCerny
Address number anq street) Address(number anq street)
11'3 Lo A'- �,` CI- 11 3Co )v • ✓V1 ca•t Si-
City,state,iaid ZIP Code City,state,an•�IP Code ��MC.,, vri_ Z .nf 4rj G? 'IC, T_r Ate.4ZI y.-
r:NG Country
Countryt.,. ) 5 1 VS 4
Under d penalties and isu I hereby rd thiswith ICles 1sclosure,to the best of my knodedge and belief,is true,6-1 1-5.5.A person who knowingly and intentionally falsifiesrthet value of transferred
required by law,and is prepared in accordance
real property,or omits or falsifies any information required to be provided,corn is a Level 5 felony.
Si at rye off...nI�J� ® Si natur ,j,Seller t//I^ `, J�J
�` — le -'--- • r•t�'ig anted ,aammJee of er �J/ Date signed(mm/dd/yyyy)
inted Name of Selle�r Date signed(mm/dd/yyyy) 02/25/2022gned
Christopher M. Da�Jts 102/25/2022 Cerny N. Day
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THATo APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears onFy,� D
Carinda Cox , 1■■
Address(number and s et) Address(number and street)
St)6 .. • Hell
n r ro c^> Po Z D r• City,state,and ZIP Code MAR 0.7 2022
City,state,and ZIP Code +�.� / ���
Q(..�Chlv•ti a I- ,,A $ Country 1�jdf+�vnd�
Country 5 `�h � Q.Y AUDITOR44&
V "/ Email address (311360N C U Telephone number
E-mail addresg
to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 0 3. Homestead
1.Will this property be the buyer's primary
C) u O O residence? 4. Solar Energy Heating or Cooling System
/ 0 [] 5.Wind Power Device
CS Does the buyer have a omestead to be vacated
for this residence?If yes, homestead
address: 0 C) 6. Hydroelectric Power Device
Address(number and street) 0 C) 7.Geothermal Energy Heating or Cooling
g-Device
City,state,ZIP code,and county ac-t--1 -Q,^�3 0--' -ni1- -V-2`.
and belief,is true,correct and
as drequired lties
I.of . dury,I hereby certiy Is prepared In acfcorda`nce with IC 6j 11-5.5.A person who knowinglyfande complete
this Sales Dsclosure,to the best of my intentionally falsifies the value of
transferred ,: prop,rty,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
5