Homestead_Rodriguez H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
1. SELLER(S)/GRANTOR(S)
Seller 1-Name as It appears on conveyance document Seller 2-Name as appears on conveyance document
PATRICIA A. HUNT
Address(number and street) Address(number and street)
6627 N State Road 65
City,State,and ZIP Code City,State,and ZIP Code
Hazleton, IN 47640-9336
Country Country
E-mail Address Telephone Number E-mail Address Telephone Number
Under penalties of perjury,I hereby certify 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 transferred
real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.
1 Sign ure of Selle`rr/ Signature of Seller
e
fidur
Printed Name of eS llhT Date Signed(mmldd/yyyy) Printed Name of Seller Date Signed(mm/ddlyyyy)
PATRICIA A.HUNT April 28, 2023 April 28, 2023
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document :.ryer 2-Name as It appears on conveyance document
LUIS A. RODRIGUEZ 1 .
Address(number and street) Address(number and street)
6627 N State Road 65
City,State,and ZIP Code City,State,and ZIP Code
Hazleton, IN 47640-9336 � trP .4.4.741,
Country Country 4 ,O �Q
.,ly for certain deductions.Identify al ) pIy:
YES NO CONDITION YES/ NO CONDITION j'
1.Will this property be the buyer's primary r[VQ/ D 3. Homestead Av4/rOR
❑ residence? ❑ ig
4.Solar Energy Heating or Cooling System
r i i 2.Does the buyer have a homestead to be vacated ❑ rig5.Wind Power Device
for this residence? If yes, provide address: El U 6.Hydroelectric Power Device
Address(number and street) ❑ 7.Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County 3 C 0 5-- p l _40 O—td O. ‘ i—_o t
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete