Homestead_Willingham H. PREPARER
Preparer of the Sales Disclosure Form Title
Megan Boger 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
Chase Vincent Goldbach Kimberlee Ann Goldbach
Address(number and street) Address(number and street)
City,stale,and ZIP Code City,state,and ZIP Code
Country Country
US US
required by law,and Is prepared In accordance with IC 6-1.1-5.6.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)
Chase Vincent Goldbach 09/06/2022 Kimberlee Ann Goldbach 09/06/2022
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
Elizabeth Willingham
Address(number and street) Address(number and street) Pi
�
14552 Georgia Avenue
City,state,and ZIP Code City,state,and ZIP Code tb
Riverview, MI 48193
Country Country 'Se/D 7Z
US
apply for certain deductions.Identify all offt/148o
YES NO CONDITION YE NO CONDITION A0O/TOR
1.Will this property be the buyer's primary CI 3.Homestead • \ J
O O residence? 0 l 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated O t] 6.Wind Power Device
0 yl 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 Z-1.9 7
/7 7
.f6.3- O/ /f oa?
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete