Homestead_Stephens (4) H. PREPARER
Preparer of the Sales Disclosure Form Title
Megan Boger Escrow Officer
Company-
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I. SELLER(S)IGRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as ears on conveyance document
Barbra J. Medcoff
Address fnumber and skeet) Address(number d stItik,
V.On M. 1-mv- ?-katy, M I
CU,state,and,ZIP Code City,state,and ZIP Code
v_Aoo\p1/109otr) ln40 (
Country Country 1 3
US us ..,_. , 2023
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A person who knowingly and ingMf4alsiflos the value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of Signature of Seller
Printed Name of Seller s'gned(mm/dcVyyyy) Printed Name of Seller Date signed(mm/dcl/yyyy)
Barbra J. Medcoff 1 7 12125
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
William Joseph Stephens
Ad,..se .i!nurberr. 7dst -79 _ Address(number and street)
LI - ,i-Now(7 c-
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City, Ni )
te,and ZIP Code City,state,and ZIP Code
riv le-f--to • -/.--' hii70
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Cb"rifry- i Country
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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
1.Will this property be the buyer's primary 0 0 3. Homestead
CI 0 residence? o C) 4.Solar Energy Heating or Cooling System
p4 2.Does the buyer have a homestead to be vacated 0 C) 5.Wind Power Device
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
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City„state,ZIP code,and county 6 .. I a, -07403 -,,, 6c
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
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