Homestead_Czak 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 conveyance document
Robert A. Arnett II Jessie K. Loehr
Address(number and street) Ild.ress(number antistreett
1(A(0 RO S Litfi M)t)
Ci state,and ZIP ode statc,arid ZIP Code
' IrG (' ) . lo Lig hr A 11 C to )k) kf-7tr)(1,
Country Country '
USA USA
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 ,.. /Signatureof'seller
'044144------ -345/23 A J:f Ja - (RA/1/x.
Printed Name of Seller Date signed(mm/ddlyyyy) Printed me of Seller Date signed(mm/dd/yyyy)
Robert A.Arnett,II March 13, 2023 Jessie K.Loehr March 13, 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 cony an cument
Blake Alexander Czak
Address(number and street) Address(number and street)
I
509 South Hart Street -tb
City,state,and ZIP Code City,state,and ZIP Code 4114 /5
Princeton, IN 47670 ,
,
Country Country . _,
USA %&o c
Form may be used to apply for certain deductions.Identify all of thoseGltapply:
YES NO CONDITION YES NO CONDITION
0 1.Will this property be the buyer's primary
0 0 3. Homestead
0 residence?
0 0 4.Solar Energy Heating or Cooling System
ID w 2.Does the buyer have a homestead to be vacated 0 5.Wind Power Device
El
for this residence? If yes,provide address:
0 g 6. Hydroelectric Power Device
- ,--,
Address(number and street) L j E] 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
2-(y 1 1-;- 01-30( - Ool- Oc- ozg •
5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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