Homestead_Hawthorne 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��ce document
Estate of George David Douglas �p
Address(n ra d sire Address(number and street) )�
i9 g SKI, due i//JIl
Stale,a IP,�ode X! City,state,and ZIP Code D,
Country Country s�, e.,/
to the best of my knowledge and belief,is true,correct antecomplete 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.
Si nature of Seller p- -_ - Signature of Seller
Printed Name Seller Date ig ed( dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Susan J. Bierman, Executrix 1 a`�e-o 1
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
Todd J. Hawthorne Jennifer Hawthorne Jennifer Hawthorne
Address(number and street) Address(number and street)
886 West McCarty Road 886 West McCarty Road
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country
Country
li 1.Will this property be the buyer's primary El 3. Homestead
❑ residence? J ''' J 4.Solar Energy Heating or Cooling System
s{� 2.Does the buyer have a homestead to be vacated D -1/1 5.Wind Power Device
❑ -Ind-for this residence?If yes,provide address: ❑ n 6.Hydroelectric Power Device
Address(number and street) 0 li, 7. Geothermal Energy Heating or Cooling Device
City,state.ZIP code,and county e} / -1�1 - 1 3- `Q�_ O O(-k -\,/l 6- _0 2-1- .
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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