Homestead_Cross 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
Address(number and street) Address(number and street) G7
218E 850 N.
N
City, State and ZIP Code City, State and ZIP Code Z C
Hazleton, IN 47640 r
Country Country c 4::,United States of America United States of America Z+� ~'
E-mail address Telephone number E-mail address c`�.ThonPi er
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief, is truce orrect and c ete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsiti s the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of Seller Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller I Date signed(mm/dd/yyyy)
6/3/2022
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
Kyle B. Cross Emily M. Cross
Address(number and street) Address(number and street)
618 S. Old Patoka Rd. 618 S. Old Patoka Rd.
City,State and ZIP Code City, State and ZIP Code
Patoka, IN 47666 Patoka, IN 47666
Country Country
United States of America United States of America
''
YES__ NO CONDITION YES/ NO CONDITION
ad El1. Will this property be the buyer's primary residence? 6d ❑ 3. Homestead
El 4. Solar Energy Heating or Cooling System
0 m/ 2. Does the buyer have a homestead to be vacated for this ❑ " 5. Wind Power Device
residence? If yes, provide address:
0 NE/j6. Hydroelectric Power Device
Address(number and street) 0 7. Geothermal Energy Heating or Cooling De'
City,State,ZIP code,and county
Z6 -02— S l00 [-0OS . n -0n?,.