Homestead_Ortega-Terry 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)/GRANTER(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Michael Everett Price Judy Price
Address(number and street) Ad e sg(number�f'd street) 1
%IQ GrartkaC Cs ,c+ . Ap4 109 o't j S YFlncc St`
City,state,and ZIP Code Ci ,state,and IP Code
Grown Poi r-t , I 4 C930-7 F rind r -1 i/N LI7Cl7V
Country Country
U.S
E-mail address
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of My knbwiedge and elief,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.
Signature Se ler 424;4, Signature of Seller
Printed Name of Seller Date sipped(mm/�) Prints a eller Date signed(mm/dd/yyyy)
12
Michael Everett Price , 7 41 lao Jud ce 1 - 2( 20 Z2-
J. BUYERS)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1—Name as it appears on conveyance document 1 Buyer 2—Name as it appears on conveyance document
Diego Austyn
Ortega Terry T D
Address(number an treet Address(number and street) FT L
3 % tJ street)
1
City,state,and ZIP Code City,state,and ZIP Code 5 2022
Y'...La�rotn , Z}J L.V1 t 11 0 JUL 2
C:C.,..!;2)
Country Country
ilif
E-mail ress
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
Q
1.Will this property be the buyer's primary KI O 3. Homestead
residence? CI 4.Solar Energy Heating or Cooling System
• 2. Does the buyer have a homestead to be vacated Q 1 5.Wind Power Device
Q for this residence? If yes, provide address: p p 6.Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county :16-1Z-oi-t04-002 S 2 2 02,e ,