Homestead_Kielb H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers Escrow Officer
Company
Address(number and street,city,state,country,and ZIP code)
605 SE Martin Luther King Jr Boulevard,Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as it appears on conveyance document
Estate of Ronnie B.Pio,deceased
Address(number and street) Address(number and street)
206 N.Church St.
City,State and ZIP Code City,State and ZIP Code
Ft.Branch,IN 47648
Country Country
United States of America
E-mail address
Under penalties of perjury,I hereby certify this Sales Disclosure,to the 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 transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
t nature of er / Signature of Seller
Printed Na e ellerr , Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Jerry C io, Personal Representative QV ZL _02-
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 n t,_ b
ce document
MeAddrenss
Ki u Address(number and street) Address(number and street)102 N. Church St.
City,State and ZIP Code City,State and ZIP Code Apt? q
Ft.Branch,IN 47648 > G 7 2022
Country Country C,
United States of America I BSON r0 1�l� ,
E-mail address
OR
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YS/ NO CONDITION YES NO CONDITION
El 1. Will this property be the buyer's primary residence? ❑ 3. Homestead
7' ❑ El4. Solar Energy Heating or Cooling System
❑ py 2. Does the buyer have a homestead to be vacated for this ❑ El 5. Wind Power Device
residence? If yes,provide address: ❑ p 6. Hydroelectric Power Device
Address(number and street) 0 El 7. Geothermal Energy Heating or Cooling Device
City,State.ZIP code,and county q \8 - \-OOO- -, ` _O.t o
3