HomeMy WebLinkAboutHomestead_Saliju (2) H. PREPARER
Preparer of the Sales Disclosure Form Tills
Milton Norman ..... Settlement A$ent
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Company E-mail address
Address(number and street,city,state,country.and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708
I.$ELLER(S)IGRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Jennifer A.Seibert Beth A.Ross
Address(number and street) Address(number a et)or clittcci ?id
2384 W. 1000 S .
City,state.and ZIP Code - City,state,and ZIP Code L� �� . ,
Haubstadt, IN 47639 y " �' r-
Country Country +.
US US
E-mail address
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and Intentionally ..-Hies the value of transferred
real property,or omits or falsifies any Information required to be provided,commits a Level 5 -
,Signature of Seller 1 c . t.. , Signature of Seller
1 � \�\ `\\\ .i�,V�`,' ;
Prim a4tetier Date signed(mm/ddryyyy) Printed Na - Date signed(mm/dd/yyyy)
Jennifer A eibert 06/06/2023 Beth A.R•ss IA Pr 05/25/2023
J. BU YER(S)IGRANTEE(S)-APPLICATION FOR PROPERTY TAX D . • ONS ti- % ALL T - •
Buyer I-Name as it appears on conveyance document ` Buyer 2-Name as it appears on conveys document
, ; \\ j A ;% v , Zenel Saliju
Address(number andstreet}i Address(number and street)
7885 S. 10 E 7885 S. 10 E A'('a')j
City,state,and ZIP Code City,state,and ZIP Code ..i2 e
Fort Branch,IN 47648 Fort Branch,IN 47648
Country Country
US US
YES NO CONDITION YES NO CONDITION
® O 1.Will this property be the buyer's primary ® 0 3.Homestead
residence? 0 Gi 4.Solar Energy Heating or Cooling System
.‘ 24 Does the buyer have a homestead to be vacated 0 ( 5•wind Power Device
For this residence?If yes,provide address: 0 Gi 6.Hydroelectric Power Device
Address(number and street) C) oj 7.Geothermal Energy Heating or Cooling Device
915 Chickasaw Dr
City,state.ZIP code,and county <DLL- 19 -' Q - 3- O C(. ;, Ol^'40II/ „
Fort Branch, IN 47648 Oo� l51 ,
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