Homestead_Harner 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)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Nga Tuyet Tran
Address(number and street) Address(number and street)
1.19 r a c,.A_, y .533
City state,and ZIP Code City,state,and ZIP Code
Pr' 311N `I'7 (o I)
Country Country
E-mail address
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 of Seller Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Nga Tuyet Tran 073-
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1—Name as it appears on conveyance document
E-mail address
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary ,moo(/ 0 3.Homestead
residence? 0 O 4.Solar Energy Heating or Cooling System
-� 2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes, provide address: 0 C) 6. Hydroelectric Power Device
Address(number and street) O O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
6-11 -�2�zo4 - 002 -q r- o2s .
N.d H onne_S4e cx.ck -Vac
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