Homestead_Etolen (5) 1 H. PREPARER
Preparer of the Sales Disclosure Form Title
Cody L Pruett Closing Agent
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 cor�oydn� ument
The Estate of Fern Peavler
Address(number and street) Address(number and street) 'kb
/ a o �5 S • IN
rt4 t Ave-, kA
City.State,and ZIP Code City,State.and ZIP Code
{ ( S a Country O 20
Country C,/gsO ��
Email Address
best of my knowledge and belief,Is true,cor,6t,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
Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Vicki L. Mosier a— p v�__ZJ
.1- 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
Anthony E. Etolen
Address(number and street) Address(number and street)
1(QO S r'fla S4-•
City.State,and ZIP Code City,State,and ZIP Code
?r i fv- fhrl. OJ er7Cp"r c)
Country Country
Ema ddress
NO CONDITION
VI 1.Will this property be the buyer's primary O 3. Homestead
O residence? O 0 4. Solar Energy Heating or Cooling System
O Ig 2. Does the buyer have a homestead to be vacated O O 5.Wind Power Device
for this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) 0 Q 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County `a6'V•L_ IS"3 O 2_(30 ' 1 O —0 Zg
COPY