Homestead_McDaniel H. PREPARER
Preparer of the Sales Disclosure Form I Title
i Amanda Daly. 1 Settlement Agent --.
fCompany —_� ----
Address(number and sfreet city.stale.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 co ance document
AngelaL.Sams It,pt)Addreress(number and street) Address(number and street)
1812 S 1200E
City,state.and ZIP Code City.state.and ZIP Code AU"Oakland City,IN 47660 O'7 2022 )—
Country Country US
GtBSO
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 property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature • -- =r Signature of Seller
>� �— �( i
Pri led Na - of Seller Dale signed(mm/ddlyyyy) Printed Name of Seller Date signed(mmldd/yyyy)
Angela L.Sams 08/03/2022 08/03/2022
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
Wayne R.McDaniel
Address(number and street) Address(number and street)
110 N.Madison St _
City,state.and ZIP Code City.state,and ZIP Code
Oakland City,IN 47660
Country Country
US
for certain deductions.Identify all of those that apply:
t YES NO CONDITION ES NO CONDITION
N 1.Will this property be the buyer's primary i 0 3. Homestead
- ?,0 residence? /O CX 4.Solar Energy Heating or Cooling System
o A 2.Does the buyer have a homestead to be vacated 0 t 5.Wind Power Device
D O for this residence?If yes,provide address: D a 6. Hydroelectric Power Device
Address(number an street)
o ( �( � � .�f‘c'Itc.anty
p [X 7.Geothermal Energy Heating or Cooling Device
M f
\ Cit sta -. lP code.
p" U• ► ', *4 /WWI trUto&O ' " c__Ick-ici ---)-03-001 - 05-D - cob .
t Under penalti • perj ,I he e, , ertify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
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