Homestead_Hallam H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street, city,state, country and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S) _ _�
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on convey nc ent I
DEBORAH KAY CARROLL
EB - - ,
-4e_b
Address(number and street) Address(number and street)
6555 Evening Song I.ane `JUL
9
City,State,and ZIP Code City,State,and ZIP Code / 20��
Owensville, IN 47665-9690 _ j _j
[ Country Country G/e�
1tE-mail Address Telephone Number E-mail Address ON Cn� .0 a Number
n/TOR
Under penalties of perjury,I hereby certify 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. ,
Signature of Seller � I
I Signature of Seller
H ~
fi('�`11 VIA
Printed Name of Seller -T Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm!dd/yyyy)
I DEBORAH KAY CARROLL 'July 21, 2023 I July 21, 2023
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document I Buyer 2-Name as it appears on conveyance document
KEVIN EUGENE HALLAM _ 'JEANETTE RENEE HALLAM
Address(number and street) I Address(number and street)
500 S Cathy Drive — - - 1500 S Cathy Drive —
City,State,and ZIP Code !! City,State,and ZIP Code
Princeton, IN 47670-2606 !Princeton, IN 47670-2606
Country I Country
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
El ❑ 1.Will this property be the buyer's primary ❑ 3. Homestead
residence? 0 d 4.Solar Energy Heating or Cooling System
�/ 2. Does the buyer have a homestead to be vacated ❑ [y� 5.Wind Power Device
0 JJJJJJ for this residence? If yes, provide address: 0 1]( 6. Hydroelectric Power Device
Address(number and street) El [ 7.Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County 2--6 -I' _ I _ . .0 2 ^G,O u "9-2._ - 02±
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
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
S_.,,_ o-v-v-\ -4 S v \c �8. 3 >--1) a-o\-"`6-(Lil C). c c c;
NOTARY PUBLIC State of OK i A C r y'\
• K. CATER •
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Comm. 0 04005732 i 1p-as',),O c - \
! Pottawatomi• County