Homestead_Hatchett H. PREPARER
Preparer of the Sales Disclosure Form Title
Amy B. Pollard Settlement Agent l
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201, Evansville, IN 47715 ,
I. SELLERS)/GRANTOR(S) 11
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance docume a
Daniel E.Roberts Brooke(Schulze)Roberts
Address(number and street) Address(number and street) OCT 1 1 2023
801 E Walnut Street 801 E Walnut Street � \
City,State,and ZIP Code City,State,and ZIP Code I ) '
Fort Branch, IN 47648 Fort Branch, IN 47648 GI gs d^ r
Country Country ON COU AUDIx J
US US OR
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.
Si re of Seller. Signatur Iler
Printed Name of Seller Date Signed(mm/dd/yyy i Printed Name o Seller Date Signed(mm/dd/yyyy)
Daniel E. Roberts 10/03/2023 Brooke(Schulze)Roberts 10/03/2023
J. BUYERS)/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 ap
pears pp y y on conveyance document
Tyler W.Hatchett Cameron R. Hatchett
Address(number and street) Address(number and street)
400 S Main Street,Apt C 400 S Main Street,Apt C
City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648 Fort Branch, IN 47648
Country Country
US US
YES NO CONDITION YES NO CONDITION
1. Will this property be the buyer's primary ® 0 3. Homestead
y j residence? 0 ® 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 N 5. Wind Power Device ,
tl for this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
Address(number and street) Q ® 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County
c)t.- 19' t - C�, — COO G kl- 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
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