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HomeMy WebLinkAboutHomestead_Odom (3) H. PREPARER Preparer of the Sales Disclosure9 Form pp / _Ti Title _.._._" (/CCE. _1'/►�,O-L a Title Company_ Company __-_.� -- Address(number and street.city.slate.country,and ZIP Code) 7820 Eagle Crest Blvd.Suite 201,Evansville,IN 47715 I. SELLERS)/GRANTOR(S) Seller 1-Name as it appears on conveyance document Seller 2-Name as appe rs on conveyance docun� t Micki R.Lemke V1�( I-, ,` e.(,?h Q]I7 o 1.11 Address(number and street) Address(number and street) O ` 511 N Polk Street 511 N Polk Street n C �� City.slate.and ZIP Code City.state.and ZIP Code O Fort Branch,IN 47648 Fort Branch,IN 47648 ? Country Country iv US US > rw t`�, best of my knowledge and belief.is trildrUorrect 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- `Si nature of Se er 7 -5-- a 7 Signature of Seller Printed Name of Seller Date signed` (mm/dd/yyyy) Printed Name of Seer" Date signed(mm/ddfyyyy) / Micki R.Lemke 1 t 2-/ _ V c k( L 2ci n har rt-_ i - 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 Kirk Men Odom Kyra Marie Smith AddrelnumberAnd street) — tygn A-- J Addres"(jber street o .) (A--- _ �1e City.st .art IP• ode t KS "l 1 L lr _ Gify S VL �___C 1 v (� - -- Country o nlry YES NO CONDITION p0 0 1.Will this property be the buyer's primary ® 0 3.Homestead residence? 0 (g 4.Solar Energy Heating or Cooling System 0 1p2.Does the buyer have a homestead to be vacated 0 I 5.Wind Power Device for this residence?If yes.provide address: 0 Q 6.Hydroelectric Power Device Address(number and street) 0 12 7.Geothermal Energy Heating or Cooling Device City.state.ZIP code,and county 6-t O --)3-401 -G0 ©S6 -626 Number Page 3 of 5 Jr - , -------------- Page 3 of 5 /� Page 3 of 5 O Go 6. Is the seller financing the sale?(If yes, answer questions 7-8)