Homestead_Dilbeck (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Gourley Title C erk
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
Zachary R. Bell Katarir,a J. Bell
Address(number and street) Address(number and street)
ILaLA Eel 4.- `1enr,eY56A K-eL.
City,stale,and ZIP Code City,state,and ZIP Code
b
County �o� ut'11ee Co�TAM Z l
Country
E-mail address
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.
azure of Seller (� _` Signna, .ree of Seller /
Q... 45 fi'�'f ({ cs:r�s-9 16e '
Print Name of Seller Date signed(mm/dd/yyyy) Printed N me of Seller I Date si ned(mm/dd/yyyy)
'Zachary R. Bell 7//.�lo'�oZ Katari-iaJ. Bell 77/5Ja,�
J. BUYER(S)/GRANTER(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
Drew Michael Dilbeck
ddree7ss(number andstreet)e Addres;(number and street)
x /5t.s ZIP Co Code
\-ov-§e r Cz.), LEI)
ty,state,and ZIP Code City,state,and ZIP CodeP./
/(Duief\s::UC'. ,I/) , 1 7(.RCo
Country
apply fo-certal eductions.1deert�iitAll. pV that apply. \ /�w
YES O CONDITION YES N CONDITION eVM7-yJ��
1.Will this property be the buyer's primary O 3.Homestead AUQ
irOt
0 residence? O O 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 C) 5.Wind Power Device
0 for this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county .6\4-IS _O 3 oo -O O Q Or1 Z -- �2 2-Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
COP '