Homestead_Dant H. PREPARER
Preparer of the Sales Disclosure Form Title
StacyBrown Settlement Agent
...... ............. . ,.....,..= 9
Address(number end street.city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN 47715
I.SELLERS)/GRANTOR($)
Seller 1—Namo as it appears on conveyance document Seller 2—Name as appears on conveyance document
David L.Fithian
Address(number and street) Address(number and street)
8055 S 600 W
City,state,and ZIP Code City,state,and ZIP Code
Owensviile,IN 47665
Country Country
US Telephone number
E-mail address
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 r whits"..-f taffies any Information required to be provided,commits a Level 5 felony.
Si na Jen- .- Signature of Seller
I Date signed(mmrdd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Printed Nam er 1 03/02/2022
David L.Fithian 03/02/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 2-Name as it appears on cone anceED
documen t
Buyer i—Name as it appears on conveyance document Y Darrin T.Dant
Address(number end street) Address(number and street)
3710 Broadway Ave.
City,slate,and ZIP Code City,state,and ZIP Code MAR 0 8 2022
Evansville,IN 47712
Country Country tir ,,/,-
US ' 144I AUDI R
ettrifllet4 COU
E-mail address
certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary ® 0 3.Homestead
0 residence? Cl all 4.Solar Energy Heating or Cooling System
O � 2.Does the buyer have a homestead to be vacated CD MI 5.Wind Power Device
for this residence?If yes,provide address: 0 (33 6.Hydroelectric Power Device
—
Address(number and street) 0 ca 7.Geothermal Energy Heating or Cooling Device
q(
City,state,ZIP code,and county - O1_ 30 „QOG. g SO -agoic
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the beat of my knowledge and belief,is true,correct and complete
5
copy 0 PY