Homestead_Burns (2) . H. PREPARER
•
Preparer of the Sales Disclosure Form Title
Courtney Pruett Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave, Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyanc- °
Zechariah W. Adams Haleigh D. Adams �.
Address •" and street) , Address(number and street)
State,Z 7/0 r-,45 5 re A -we ed Or-vC :11P
• ZIP Code City,State,a
MAR , 0
o ' rfr* ) 2O23
Count
Country •
I■
{ l
ri,A �'�`''
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,Is true,correct,and cow".lete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knwingly and intentionally falsifies the value of transferred
realpyoperty,or omits or falsifies any Information required to be provided,commitsa Level 5 felony.
Signs, true o •• •r ( % Sign re o'Sell•r
'rime.: Name of Seller Date Signed(mmldd/yyyy) Printed •-rre.'.y Seller Date Signed(mm/dd/yyyy)
Za ha ah W. Adams ; / 3 Haleigh D.Adams 5i t2-4-).-)--
_
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—Naame as it appears on conveyance document
Nicole Burns
Address(number and street) Address(nufnber and street)
53 5 \Fst .
City,State,and ZIP Code City,State, ZIP Code
Country Country
Email Addre
deductions.Identify all of those that apply:
YES NO CONDITION YES, NO CONDITION
O 1.Will this property be the buyer's primary 0 3. Homestead
residence? 0 D 4.Solar Energy Heating or Cooling System
0 2. Does the buyer have a homestead to be vacated D D 5.Wind Power Device
for this residence? If yes, provide address: 0 D 6. Hydroelectric Power Device
Address(number and street) p D 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County 4(-12- 0Q- 30Z —O02. 2.12— 02.4 .
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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