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Homestead_Gick (2)
H. PREPARER Preparer of the Sales Disclosure Form Title Matthew Jarvis 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 it appears on conveyance document Melissa Miller Address (number and street) Address (number and street) 104 Ben St. • City, State and ZIP Code City, State and ZIP Code '4114:4.4(6 Haubstadt, IN 47639 4 Country Country f6' United States of America 0: . �0?� E-mail address , knowingly and intentionally falsi itf.b alue of transferred real property, or omits or falsifies any information required to be provided,commits a Level 5 felony. )(Signature of�Seller M � � Signature of Seller Printed Name of Seller Date signed (mm/dd/yyyy) Printed Name of Seller Date signed (mm/dd/yyyy) Melissa Miller 5/31/2023 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 Owen P. Gick Address (number and street) Address (number and street) 11426 S 150 W. City, State and ZIP Code City, State and ZIP Code Haubstadt, IN 47639 Country Country United States of America E-mail address 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 © 0 1. Will this property be the buyer's primary residence? © 0 3. Homestead w``` ❑ EI 4. Solar Energy Heating or Coo ng ` ❑ El2. Does the buyer have a homestead to be vacated for ❑ El5. Wind Power Device '"'` ,;; this residence? If yes, provide address: ❑ C�1 6. Hydroelectric Power Device Address (number and street) ❑ El 7. Geothermal Energy Heating or Cooling Device City, State,ZIP code, and county I - 3 6e - god- boo . oqc/ ao/ 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 information, SSN/Driver' License/ID/O r Number is necessary if a Homestead Deduction is being filed.) Signature of Buyer p Signature of Buyer 2/Spouse /— Printed Legal Name,of Buyer 1 Sign Date (MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY) Owen P. Gick 5/31/2023 ` /Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Number Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number XSSN- '7 t1-1 '2(l TAB rv_i ?7717