Homestead_Ziliak (15) H. PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent_-._.� -
Company E-mail address
Address(number and street,city,state,country,end ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708
I. SSELLER(S)/GRANTOR(S). .. ... .
Seller 1-Name as It appears on conveyance document Seller 2-Name as appears on vey
nc docu I
Sarah O.RIgg f/k/a Sarah O.Jost
Address(number and street) Address(number and street)
-307-8-Vreat- . -i 5- . /oa 55 4P6?28
City,state,end ZIP Code Cliy,state,and ZIP C o zo?3 /�
Haubstadt,IN 47639 //
Country Country Q/eSQ \
US • C'OV` .1,
the boat of my knowledge and belief,Is true,correct and complete as
required by law,and is prepared in accordance whit 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.
Sign lure of Se et Signature of Seller
r
Printed Name of Seller Date signedig1 (anrv'ddlyyyy) Printed Name of Seller Oats signed(mmfdd/yyyy)
Sarah O.Rigg flk/a Sarah O.Jost 04/E 023 04/28/2023.
J. BUYER(S)IGRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1•-Name as it appears on conveyance document Buyer 2 m Name as it appears an conveyance document
Mitchell J.Ziliak
Address(number and street)) Address(number end street
5373 F 1-1..50-S- t:y 7 ') 1,.l"`SA, ` .\--
City,slate,and ZIP Code City,slate,and ZIP Code
,�•. Haubstadt,IN 47639
(v Country Country
0 US
certain deductions.Identify all of those that alley:_
0 YES NO CONDITION - YES NO CONDITION
1,Will this property be the buyer's primary IX) 0 3. Homestead
CD ® residence? 0 so 4.Solar Energy Heating or Cooling System
I
cal d O 2,Does the buyer have a homestead to be vacated 0 5,Wind Power Device
for this residence?if yes,provide address: p ® 6.Hydroelectric Power Device
r,•J Address(number and strri) �� 0 r. T.Geothermal Energy Heating or Cooling Device
632:5
i City,slate,HIP code,and county G b.�1 S - (t(ril`—00 c -
bk,,`0 •-.0 o Ct I
I'la��s'k;off Z>\37 �9 G��so� U� l "1V
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
�9 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 S felony.(Note:tiot spouse's
information,SSW/Driver's License/ID/Other Number is necessary If a Homestead Deduction is being filed.)
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