Homestead_Ziliak (14) H. PREPARER
Preparer of the Sales Disclosure Form Title
Escrow Officer
Matthew Jarvis
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
Shara L.Walker
Address (number and street) Address (number and street)
9961 S. Misty Lane
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639
Country
Country
United States of America Telephone number
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.
ignat��)of Seller �� J Signature of Seller
Sed Name of �j%L6�Xy I Date signed (mm/dd/yyyy)
Printed Name of Selle Date signed (mm/dd/yyyy) Printed Name of Seller
Shara L. Walker 11/22/2022
J. BUYE S.}L -ANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT LY
:.yer 1 -Name as it appears on conveyance document
B - •• •- as it appears on con a e ocu en
' Barbara Ziliak . Dennis Schmitt
; ,•' 0.- : . street) .. •ddress n .••- .nd street) NOV 3
700 Edinborough Ct. 700 Edinborough Ct. o 2022
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639 4C fir' -
Country GIBBON COUNTY gUDITOR
Country United States of America
United States of America
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION Y
El
1. Will this property be the buyer's primary residence? o �d
Q 4. Solar Energy Heating or Cooling System
❑ ❑ 2. Does the buyer have a homestead to be vacated for ❑ 71 5. Wind Power Device
this residence? If yes, provide address: ❑ p 6. Hydroelectric Power Device
Address (number and street) LI 171 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county _ Z7�� �_ Cl, '
07C-/9-3/- 7.1-4 �i
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
yCOPY
SALES DISCLOSURE FORM SDF ID 2022
k tM State Form 46021 (R13/12-21) County Year Unique ID
A./44044N,
t Prescribed by Department of Local Government Finance
9 - Pursuant to IC 6-1 1-5 5
PRIVACY NOTICE: The telephone numbers and Social Security numbers of the parties on this form are confidential according to IC
'�a' 6-1.1-5.5-3. Do NOT place personally identifiable information(e.g.consulate numbers,passport numbers;government ID numbers,etc.)on
this form as it may become publicly available.
NOTE: All questions must be answered to the best of the individual's ability. If the question does not apply,write"N/A"in the
space provided. If the information requested is unknown, leave the space provided blank. Failure to provide a response for the
italicized fields shall not result in the rejection of the underlying conveyance document by local officials.
INSTRUCTIONS: For additional information on how to complete this form, see the Sales Disclosure Form Instructions.
y.Tlotal number of parcels on this disclosure:
5. Other: The buyer's are selling their current homes and moving into (lf there is more than one(1)parcel, See Page 5)
one home together. Both houses will need their homesteads vacated.
1 . Select the type(s) of property below and fill out corresponding
Dennis Schmitt's homestead needs to be removed from 9421 Bender Rd p ge(s). Check all that apply.
Poseyville, IN 47633. Barbara Zilliak's homestead needs to be vacated Residential ❑ Agricultural
from 700 Edinborough Ct Haubstadt, IN 47639. (Complete Page 2,Sec. D-E) (Complete Page 2,Sec. D-E;
El Commercial CI Industrial
\Sy
(Complete Page 2,Sec. F-G) (Complete Page 2,Sec. F-G;
L Page 1
_,1'- pl ieV) 2