Homestead_Clore (4) H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers Escrow Officer
Company
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
Randal Miles Jana Miles
Address(number and street) Address(number and street)
2877 Bullocktown Rd. 2877 Bullocktown Rd.
City,State and ZIP Code City,State and ZIP Code
Boonville, IN 47601 Boonville, IN 47601
Country Country
United States of America United States of America
E-mail address
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.
S riat c:f yr • ur of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Pin Name of Se ler Date signed(mm/dd/yyyy)
Randal Miles 1/5/2023 Ja Miles 11/5/2023
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 An_� nce document
Mindy R. Clore d 7
,4 Address(number and street) Address(number and street)
160E795S. q -16:40
City, State and ZIP Code City, State and ZIP C NI
Fort Branch, IN 47648 CountryC/e r-�f °?0e,
Country Q
United States of America CO&N,`yq�� rr
Y NO CONDITION
[� 0 1. Will this property be the buyer's primary residence? ❑ 3. Homestead
❑ El 4. Solar Energy Heating or Cooling System
❑ N;172. Does the buyer have a homestead to be vacated for this ❑ ❑ 5. Wind Power Device
residence? If yes, provide address:
0 p 6. Hydroelectric Power Device
Address(number and street) ❑ p 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county 9 — I - 2'- 3
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
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