Homestead_George (2) H. PREPARER
Preparer of the Sales Disclosure Form Titte
Amanda Daly Settlement Agent _,_
Company
Address(number and street,city,state.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 c ument
Christy N Englehardt
Address(number(numbberr and street) Address(number and street) ✓�
309 E Sinclair Street
..kie::;)
City.slate.and ZIP Code City,state.and ZIP Comae 498
Fort Branch,IN 47648 SONcO - 20��
Country Country (i ,,,� U
us 'a(i%
( 45
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 p perty,or omits or falsifies any Information required to be provided,commits a Level 5 felony.
Shin it of Ilex �j/ Wei 2 -2 Signature of Seller
l/Printed Name of eller ".- F� Date siglsaa-(mm/dd/yyyyJ' Printed Name of Seller Date signed(mm/dd/yyyy)
Christy M.Englehardt 07/08/2022 - 07/08/2022
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
Mary A.George
Address.(number and street) Address(number and street)
6956 State Road 65 N -_ _
City,state,and ZIP Code City,state,and ZIP Code
Hazleton,IN 47640
Country Country
US
( )
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
1.Will this property be the buyer's primary X^ 0 3. Homestead
® 0 residence? 0 1-X 4. Solar Energy Heating or Cooling System
/ 2. Does the buyer have a homestead to be vacated O LZ 5. Wind Power Device
for this residence?if yes,provide address: 0 a 6. Hydroelectric Power Device
Address/(irumbe gndstrreet)^a tJ�� \ 0 (X 7. Geothermal Energy Heating or Cooling Device
tOg.
Wet code,and tyq 1U LND ZG--t°t-vB �301 -oo o .34 I -o z�
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
of Buyer 2/Spouse SSNIOriver's License/ID/Other Number
C OPY
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