Homestead_Miller (26) H. PREPARER
Preparer of the Sales Disclosure Form Title
Cody L Pruett Closing Agent
Company
Address(number and street,city,state, country,and ZIP Code)
4600 Washington Ave., Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S) /
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyan -• ,:nt
Mike A.Gomez
Address(number and street) Address(number and street) \
350 5 . MO ,
City,slate,and ZIP Code City,state,and ZIP Code .G//i
Pi 1 VIC•e-)sue. • I /4 4f767° �>
Country Country �'/e
E-mail address
of my knowledge and belief,is true,**>, a d comple a
required by law,and is prepared In accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies .a:�" lue of trans rr
real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.
Signs re oij r .2 Signature of Seller �—
Printed Name of Seller to signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Mike A. Gomez 4 ,-/-5. R3 _
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
Vince Lee Miller
Address(number and street) Address(number and street)
615 S Hall Street
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
USA/Gibson County
( )
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
D D 1.Will this property be the buyer's primary D D 3.Homestead
residence? 0 Q 4.Solar Energy Heating or Cooling System
❑ 2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device ,
for this residence?If yes,provide address: 0 C) 6.Hydroelectric Power Device
Address(number and street) 0 1 7.Geothermal Energy Heating or Cooling Device
(11(0 W .Sov-I-L b '-
City!,slate,ZIP code,and county
o-
01,, P a�, v c7 ( 6,e f(5 abr\Z—b 7-3U -floc- o26 -02 '
Under penalties o?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