Homestead_Norris H. PREPARER
Preparer of the Sales Disclosure Form Title
Micah Scott Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd. Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Madison M. Coomer Richard Kelly Deffendall
Address(number and street) Address(number and street)
15 a i 3, 1711,...i'iti t 2 n-,a.; n
City tale,and ZIP Code Cit state,and ZIP Code
Pr ;"c...-A-tf.., ✓ y�.' `iCa�7C� 'ir;i ce-\-an , 3 `-1-7 07d
Country V' e1 Country
J �
E-mail address //
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my know) dge 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
re prope or omits or falsifies any information required to be provided,commits a Level 5 elony.
Si to e #., ,,„,,.....4,_,
atur of Seller
,6_,1,0,. ..,-------,--eZ/e
Pnn d Na of Seller Date (mm/dd/yyyy) ed Name of Seller Date signed(mm/dd/yyyy)
Madison M. Coomer 8/19/2022 ard Kelly Deffendall 08/19/2022
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 con nce document
Sydney D. Norris ILElb
Address(number and street) Address(number and street)
5u ) F'_ 0,1,.. Si .
City,stat nd ZIP Code City,state,and ZIP Code
FO Y { 4 ,„„,,,,, -TA' LI`7(g 4 UG 2 42022
ry
Count f✓ Country G/ `-,,,.,,,s
E-mail address
•
Pursuant to IC 6-1.1- 2-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that/apply:
YES NO CONDITION YES NO CONDITION
O O 1.Will this property be the buyer's primary O 0 3. Homestead
residence? 0 O 4.Solar Energy Heating or Cooling System
O 1'I Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence?If yes,provide address: O O 6. Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
Under penalties of perjury,I hereby certify that 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
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