Homestead_Davis (35) H. PREPARER
Preparer of the Sales Disclosure Form Title
Payge Marx Escrow Officer
-
Company
Address(number and street,city,state, country,and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document .
Bruce Blaize - Kimberly Blaize
Add(ess(number and
Li 0 1 - street) je Address(number and steet)
rtoclwM- - o
r-e
City,
-
state,and ZIP Code City,state,and ZIP Code
Or\0“j-ty 1 1 -.1 'Ai 41,0 P A\Ausu n I,ti 41,OD
Country Country
US US
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 omit r falsifies any information required to be provided,commits a Level 5 felony.
Si ure of Seller
irr
r ig 'lure of
ted Name of el eller
fin A Oi_i
Datg signed(mm/ddlyyyy) Printec Name of Seller% }
te signed(mm/dd/yyyy)
Bruce Blaize U I al I,9.0 .-, Kimberly Blaize L-,
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
Lance R. Davis
Address(number and street) Address(number and street)
2150 Fosters Way Apartment 20 1144)
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670
Country Country
40
for certain deductions.IdeketjaQt4o.5e that apply:
YES NO CONDITION YES NO CONDITION `-'4,21,"
1.Will this property be the buyer's primary Cl 0 3. Homestead
‘41'0,4,
0 0 residence? 0 0 4.Solar Energy Heating or Cooling Syste
2. Does the buyer have a homestead to be vacated 0 1 5.Wind Power Device
D for this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county - a7
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
Last 5 of SSN:
Page 3 of 5
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41