Homestead_Moses H. PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent_-�,� , __ ,
Address(number and street,city,state,country,and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708
I SELLER(S)/GRANTOR(S)
Seiler 1-Name as it appears on conveyance document YY _ Seller 2-Name as appears on conve document
Mitchell J.Ziliak
Address(number and street) Address(number and street)
5323 E 1150 5 , , „, 1,4_, a4.
City,state.and ZIP Code . City,state,and ZIP Code ,/ :.'
1,t
f Haubstadt,IN 47639 (/���
,
Country Country Z,0
1 US Gipe ' 3
1 E-mail address
to the best of my knowledge and belief,is bake,,,,„ and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally fall( aloe of transferred
1 real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. . R
Signature o Sell
, Signature of Seller
Prim Name of Seller Data signed(mn/dd/}yyy) Printed Name of Seller Date signed(mrn'dd'yyyy)
I Mitchell J.Ziliak _, e,--30-R3 05/12/2023
J. BUYER(S)IGRANTEE(S)Q APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
'I Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears an conveyance document
Victoria M.Moses
j Address(number and street) Address(number and street)
i 400 S West St
City,state.and ZIP Code • City.state,and ZIP Code
i Haubstadt,IN 47639
f
) Country Country
1 US
I E-mail address
( )
uantto IC 6-1,1 12.44,the Sales Disclosure Form may be used to apply for certain deductions.'dainty a0 of those that apply:
YES NO CONDITION ) YES NO CONDITION �e
0 1,Will this property be the buyer's primary 0 O 3. Homestead
1 residence? ` u CS 4.Solar Energy Heating or Cooling System •
2.Does the buyer have a homestead to be vacated : G ® 5.Wind Power Device
I for this residence?If yes,provide address:
��- p ® 6.Hydroelectric Power Device
1, Address(number and street) [3 ►, 7,Geothermal Energy Heating or Coding Device
f City:slate,ZIP code,and county , q / ,--2.-S-l2- kb 2-002 -7 s 3 - a 2_4
:1j t cI
7 .1' st' it