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Homestead_Hatfield (4)
H. PREPARER Preparer of the Sales Disclosure Form Title Abbigail Moers Escrow Officer Company Address (number and street, city, state, country, and ZIP code) 605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713 I. SELLER(S)/GRANTOR(S) - Seller 1 -Name as it appears on conveyance document Seller 2-Name as ' pp onveyance document Rodney W. Payne Address (number and street) Address (n8-Nd treet) %rO 6200 S.650 E. ` 0-ti (4' ,l City, State and ZIP Code City, State and ZIP Coo ( 'SC)CL Fort Branch, IN 47648 Oj.. Pvp� Country Country ,�ovc��l United States of America �t�0 E-mail address best of my knowledge an elief, ist�e� rrect and complete as required by law,and is prepared in acc ance with IC 6-1.1-5.5.A person who knowingly and ionally falsifie Clue of transferred real property, or omits or falsifies y inf mation required to be provided,commits a Level 5 fkgs 7f� ell -- Signature of Seller ON Coo ...//_, '---- 417-1 'e . Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller A�Dtiaj signed (mm/dd/yyyy) Rodney W. Payne 5/30/2023 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 conveyance document Johnathan Hatfield Vanessa Dean Address (number and street) Address(number and street) 1646 R A West Hwy. 1123 E. Virginia St. City, State and ZIP Code City, State and ZIP Code Delbarton,WV 25670 Evansville, IN 47711 Country Country United States of America United States of America Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply: YES NO CONDITION YES NO CONDITION El 0 1. Will this property be the buyer's primary residence? © 0 3. Homestead 0 El 4. Solar Energy Heating or Cooling System 0 0 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device this residence? If yes, provide address: 0 El 6. Hydroelectric Power Device Address (number and street) 0 p 7. Geothermal Energy Heating or Cooling Device City,State,ZIP code, and county Mlle- VA-Cr?'" (0- -000- - r1 (.0- Qae. Under penalties of perjury, I hereby certify that 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. (Note:Both spouse's Page 3 w • :� ; ;. r w - '