Homestead_Reed (6) H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbey Moore Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Carrie Coomer Clem, FILED
address(numtyrandstreet) Address(number and street)
U t.' c r
City,state,an ZIP Code -11 City,state,and ZIP Code MAY 1 0 2022
Country t Country
USAY AUD
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.
Signature of Sell c ej Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Carrie Coomer Clem
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
Peggy S. Reed
Address(number and street) Address(number and street)
802 East Walnut Street
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648
Country Country
USA
( )
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:
YES NO CONDITION YES NO CONDITION
O O 1.Will this property be the buyer's primary CIO 3. Homestead
residence? O O 4.Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes, provide address: 0 O 6.Hydroelectric Power Device
Address(number and street) O O 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county -v -0-3 O4- 0 O0. 3'O - 0 Z 6
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