Homestead_Roberts (3) H. PREPARER
Preparer of the Sales Disclosure Form Title
Payge Marx Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Alit Saliju Florent Saliju
Address(number and streiet1 Address(numberand st et)
l ,* C
S&.5 S . 10 E _ '3825J C Stjci )o L
City,st "and ZIP Coe w/ r� /� City and ZIP Code C/
1 C7/' }- tin[ J" 1�u 1� if-4- ti tC1in� 04/ ��(Q411
Country Country
US US
E-mail add cy - /i
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Si nature of Seller Si ature of Seller
t&k LA
ri ed Name of eller Date signed(mm/dd/yyyy) P nted Name oS Seller 1, yyyy)
Alit Saliju 10/04/2023 Florent Saliju Q(j-DLiE
0/04/202
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFYACil/MT/ffY
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appear o conveyance documen
Daniel E. Roberts Brooke M. Roberts 4,,,
n `
Address
East Walnut Street) ess 801 (number
Walnut Street 801 ) V
City,state,and ZIP Code City,state,and ZIP Code t/b/rOR �
• Fort Branch, IN 47648 Fort Branch, IN 47648
Country Country
9 US US
(
YES NO CONDITION YES NO CONDITION
�� O O 1. ill this property be the buyer's primary O 0 3. Homestead
•
residence? O Q 4.Solar Energy Heating or Cooling System
A
O - Does the buyer have a homestead to be vacated O O 5.Wind Power Device
for this residence?If yes,provide address: O O 6. Hydroelectric Power Device
Ad ress(number and street) O O 7. Geothermal Energy Heating or Cooling Device
601 -E \v CC 11•l .1_,i' S 1'
. City,state,ZIP code,and county ����� (_` 'n_(�_ Q(y�- O�/. X -O?�
-fir k bt Z VICIA p( v! `� / 1
•enalties of perjury,I hereby certify that . - -• es Disclosure,to the best of my knowledge and belief,is true,correct and complete
(, as require• •y law,ana is preparea I accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of
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