Homestead_Grant H. pREPARER
Prepaoarof the Sales Disclosure Form Udm
Shannon Valiant � Escrow Officer
Company ... �
Addn�so(number and street, city, ohohe, country and ZIP code)
605 SE Martin Luther King Jr�Boulevard, Evansville IN United States cfAmerica 47713
i SEiLER(S)k3RA0TDR(q' -
Seller 1 -Name as it appears on conveyance document Seller 2-N Estate of Sherry Gayle Beasley, deceased
Address(number and street) Address (number and stre et)
106 E Oak St.
City, State and ZIP Code City, State and ZIP Code
Ft. Branch, IN 47648 40
Count ry Country
United States of America
ho en
E-mail address mail address Z?ep
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge aq V�111 true co, com
required bylaw,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and Aentfia a falsiiie's the Alue of transferred
real property,or omits or falsifies an information required to be provided,commits a Level 5 felon
PZz4"tlate Evfe4d?�(mmlddlyyy Printed Nam%�o_ eller
UX
Pted Name of Seller Y) Date signed(rnm/dd/yyyy)
Buyer I -Name as it appears on conveyance document Buyer 2-Name as it appears on%'�veyance document
Kyle Grant Alyoon8impeon
Address(number Address (number and street)
��' � � \b� �� ^\\
� /'' *�x'` / .`,~, �- yY\ `.
City. State a d // /�/ City. State and ZIP Code
IN �^ ,�� / �mp » � � �/�� . |N
Country Country �
United States ofAmerica United States of America
'~��`
^��
Pursuant tolC84.i-13-44'the Sales Disclosure Form may be used bo apply forcedain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
�
O 1. Will this property be the buyer's primary residence? O 3. Homestead
' [] 0 4. Solar Energy Heating orCoog o
� Does i
~=� ' O �� �. Wind Power
th/areaidence? If provide
` [] G Hydroelectric
0� '
Address(number and street) [] 411 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, arid county �-1
~~��� ~~ ��u��x�v\ ~ �� I=T
*��'�
i � | Disclosure,1 �h b t � knowledge �be|iefis�roecorrpctandoomp|oto
Underpena|besn�po�u�y.|herebyno/�iry�hotthn nos o o �o n my �n , '
as required by law,and is prepared in accordance with IC 6-1.1-5.6.A person who knowingly and intentionally falsifies the value of transferred real property,or omits or falsifies any information required to bo provided,commits u Level afelony. (Vomo:on,h.opouae.s