Homestead_Pepper IH. PREPARER
1 Preparer of the Sales Disclosure Form L Title
l Milton Norman Settlement A$ent _____
Company E-rn all address
Address(number and street, city.state.country, and ZIP Code)
25 NW Riverside Drive,Suite 310, Evansville, IN 47708
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conve ance document
William E. Holt Karen S. Holt
Address(number and street) . Address(number and street)
310 S.Fourth Avenue ' 310 S. Fourth Avenue 14
City,slate,and ZIP Code City,state,and ZIP Code 4tb
Haubstadt, IN 47639 Haubstadt, IN 47639 ✓O/
Country Country c 26 202
US US 3
( C2)\
E-mail address
_ OVA
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally fats tue of transferred
real property,or omits or fat es any information required to be provided,commits a Level 55yffeelony, R
S gn ure of S � /jp._.______ Signalu�re off Set4Jf C71
1 r/�'
P nfbct Name of Seller Date signed(mm/dcVyyyy) Printed Name of Seler i Date signed(mm/dd/yyyy)
William E. Holt 7 /-1 i /2 0 2-3 Karen S. Holt 7�/ .23
J. BUYER(S)IGRANTEE(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
Jack N. Pepper Tamarah Pepper
Address(number and street) Address(number and street)
i 310 S.4th Avenue 310 S.4th Avenue
City,state.and ZIP Code City.state.and ZIP Code
Haubstadt, IN 47639 Haubstadt,IN 47639
Country Country
US
for certain deductions.Identify atl of those that apply:
YES NO CONDITION YES/ NO CONDITION
jV �Will this property be the buyer's primary 1✓' D 3. Homestead
sidence? Q ( d.Solar Energy Heating or Cooling System
ki 2. Does the buyer have a homestead to be vacated O ® 5. Wind Power Device
O for this residence? If yes,provide address:
0 C2 6. Hydroelectric Power Device
Address(number and street) Q ® 7. Geothermal Energy Heating or Cooling Device
City,slate,ZIP code,and county
'6 -M. ' 1 3uu -GOO. O -\L( -C)(J
Under penalties of perjury,I hereby certify that this Safes 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