Homestead_Richard (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Megan Boger Escrow Officer
Company
Address(number and street,city,stale,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
Clarence J. Hopf,Jr. Susan E. Hopf
Address(number and street) Address(number and street)
City,state,and ZIP Code City,state,and ZIP Code
Country CCountry
US
required by law,and Is prepared In accordance with IC 6-1.1-5.5.A person who knowingly and Intentional{ 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 T/j
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Dal; signed(mm/dd/yyyy)
Clarence J. Hopf, Jr. 08/22/2022 Susan E. Hopf "9& 4' 4� 022
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTI•:, - IDENTIPRA3oLL T - 410 Y
Buyer 1—Name as It appears on conveyance document Buyer 2—Name as it a•"k—rot convey r p docu
Gregary Richard Shanny Richard 4, f
Address(number and street) Address(number and street)
\ '
8433 Red Oak Drive 8433 Red Oak Drive Gp
City,state,and ZIP Code City,state,and ZIP Code O,Q
Bismarck, ND 58501 Bismarck, ND 58501
Country Country
US US
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary 1 3. Homestead
CI O residence? p C) 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated D f 5.Wind Power Device
O for this residence? If yes,provide address: p C) 6. Hydroelectric Power Device
Address(number and street) 0 f 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county D a_ II
^Mr (00Q. 'Vd0-W' L4
Under penalties of perjury,I hereby certify that this Sates 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
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
Page 3 of 5 n,-17
1444 )fb rot asttt
k
{ 4 3, <
i e�' �t'