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Homestead_Chaudhuri H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Gourley Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave, Suite 102, Evansville, IN 47714
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appe on conveyance document
Derek J. Maggard T T T
Adl#rgss(nutstberr and slrelci Address(number and st 1 L F 1 J
City state,and ZIP Code City,state,and ZIP Code JUN 2 7 2022
Vw% r s v, l k C f =N Li.-1(0(0 5-
Country Country t j�_ /L( & ./_r )
E-maw addrlress\ss
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.
\ nature of�Sysller,,,,<..,:: Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller I Date signed(mm/dd/yyyy)
Derek J. Maggard (p (r o t o O -a-
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
Robin Kumar Chaudhuri
Address(number and street) Address(number and street)
Z 72 • lkA,l L4—• --1
-
City,state,an ZIP Code City,state,and ZIP Code
t^~~ -l5\/u ) I tA s-
Country Country
I , -
E-mail address
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
'{ O 1.Will this property be the buyer's primary O 3.Homestead
JC residence? 0 Q 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: O O 6.Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county cr ,-` ( `7--).o2-coo -aL'
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