Homestead_Dilley H. PREPARER
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
219 N Hart St, PO Box 13, Princeton, IN 47670
I. SELLERS)/GRANTOR(S) �1 T
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyannc it ■ . ■ 1
Shirley M. Carey n/k/a Shirley M. Shirley 3■J L A■✓1
Address(number and street) Address(number and street)
2601 Deerfield Dr Nov 16 2029
City,state,and ZIP Code City,state,and ZIP Code
Evansville, IN 47725 }/�
Country Country ." G( a. J/Y
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.
Signature of Seller Signature of Seller
S7-IIRlei I(11. S1IIkIep ( 1-2- 2o2z
Printed Na a of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Shirley M. Shirley
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
Hayley E. Dilley
Address(number and street) Address(number and street)
816 N West St
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
usa gibson
to 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 O Cl 3. Homestead
0 O residence? 0 ID 4.Solar Energy Heating or Cooling System
O g. 2.Does the buyer have a homestead to be vacated 0 CI5.Wind Power Device
for this residence?If yes, provide address: p O 6.Hydroelectric Power Device
Address(number and street) 0 Q 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
06 - j d 7--1 o a - Cc).:: .SyS-bac
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
5