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Homestead_West (2)
H. PREPARER Preparer of the Sales Disclosure Form Title Kris Coon Escrow Agent Company Address(number and street,city,state,country,and ZIP Code) 4600 Washington Ave, Suite 102, Evansville, IN 47714 I. SELLERS)/GRANTOR(S) Seller 1—Name as it appears on conveyance document ' Seller 2—Name as appears on conveyance document Elizabeth K Weiss Irrevocable Trust Elizabeth K Weiss Address(number and street) a (nu r and` . t et - tOr — City,State,and eh e ) City, t e and 4IP yekci,4_.qA.j ,. 41 Country CountryQrrp _ Email Address 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. Sig lure oe czai Si7ureofSe)Ier Q 4 ' Printed Name of Seller Date Signe (mm/dd/yyyy) Print Name of Seller Date Signed(mm/dd/yyyy) Leo R Weiss, Trustee 9 - —,Z3 Elizabeth K Weiss by Leo R Weiss,her AIF fl— ' 3 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 Frank West Tamara West Address(number and street) Ad ress(number_ and street) 115 S . !-e{-ercly Ian-e City,State, Cit St Ie.and ZIP Code 7 7 tfctO stet 3-N 3 Country Count cpc. YES NO CONDITION '\YES/ NO CONDITION O 1.Will this property be e l' pri .ry I� 0 3. Homestead residence? 0 O 4.Solar Energy Heating or Cooling System O /2.Does the buyer have mestead . ..44111) ed 0 O 5.Wind Power Device for this residence? If yelcOrbrq address: 0 © 6. Hydroelectric Power Device Address(number and street) ! 202s O CO 7.Geothermal Energy Heating or Cooling Device G/e City,State,and ZIP Code County ab- vg -3 -40S - coo � 4- -ooq , Page 3