Homestead_Millard H. PREPARER _
Preparer of the Sales Disclosure Form Title
Abbey Moore Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4905 Theater Drive, 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
Dalton Beal
dre s(nu bar nd street) Address(number and street)
ty,state,and ZIP Cod City,state,and ZIP Code
4liCIC f-U-r , -i (1'h 1
Country Country
USA
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.
Sjga.pture of Selle
Printed Name o eller signedSignature of Seller
y�� O Date mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Dalton Beal
9/28/2022 9/28/2022
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
Maricris E. Millard
Address(number and street) Address(number and street)
223 North West Street,Apt D
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary ❑X CI 3. Homestead
0 ❑ residence? ❑ 0 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated CI 0 5.Wind Power Device
❑ for this residence? If yes,provide address: ❑ 6. Hydroelectric Power Device
Address(number and street) 0 ❑X 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county ( l 2- O-7_Z03 o 0 l _ci 0 (')—o? .
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
5