Homestead_Edrington H. PREPARER
Pre parer
er of the Sales Disclosure Form yi „A Titre
Title Company .__._,-,_________
__...------
Company
Address(number and street,city.slate.country.and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,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 ____
Estate of John R.Potts,deceased:subject to the rights of Zackery R.P
Address(number and street) Address(number and street)
507 South Stormont Street
City,state-and ZIP Code City.state,and ZIP Code
Princeton,IN 47670
Country Country
US
best of my knowledge and belief,is truo,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 Seller
r
t Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmldd/yyyy)
kd -e.fy P74,-, ilk - o5 12o 1261n-
J. BUYER(S)JGRANTEE(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
Erica Edrington
Address(number and street) Address(number and street)
—
Citwstate.and IP Con I�ILVI de 1 l Le b City.state,and ZIP Code - - -
Country l Country
US
apply for certain deductions-Identify all of those that , ]
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YES NO CONDITION NO CONDITION !��'
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1.Will this property be the buyer's primary I 0 3. Homestead r..r)4) 0 1
residence? L) ()k 4.Solar Energy Heating or Cooling 4/4rt C
2.Does the buyer have a homestead to be vacated 0 Q 5.Wind Power Device 2
( •
O for this residence? If yes, provide address: p 6.Hydroelectric Power Device o
rTw m m
Address(number and street) 0 a 7.Geothermal Energy Heating or C o ling'Device C9
City,state.ZIP code,and county
240-/Z- 617- Dy-40Dz -Bis-40,28
Under penalties of perjury,I hereby certify that 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.(Note:Both spouse's
Information,SSN/Driver s License/ID/Other Number is necessary If a Homestead Deduction Is being filed.)
Last 5 Digits of Buyer 2/Spouse SSN?Driver's License/ID/Other Number
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