Homestead_Harmon H. PREPARER —
Preparer of the Sales Disclosure Form Title
Stacey Salzman Settlement Agent
Company
l Address(number and street,city,state,country,and ZIP Code)
2301 N. Burkhardt Road, Evansville,IN 47715
I. SELLER(S)IGRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seiler 2—Name as appears on conveyance document
Andrew Michael Williams
Address(number andatreet) Address(number and street)
220 E.2nd Street , ,5-,5 taNC 9l j Q or
City,State,and ZIP Cod i ,State,and ZIP Code
Oakland City,IN 47660 1 i }
Country Country •
US •
Email Address Telephone Number
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best o y 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 falsifies the value of transferred ;
real property,or omits or falsifies any-.information required to be provided,commits a Level 5`felony.
' natur of S 'lei Signature of Seller
noted Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/ddlyyyy)
Andrew Michael Williams 10/11/2023 10/11/2023
J. BUYER(S)/GRANTEE(S) -APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTI• L THAT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on c• =y. : :ocu sent
Christopher M.Harmon
Address(number and street) Address(number and street)
825 Highland Ave T
City,State,and ZIP Code City,State,and ZIP Code O�/
Oakland City,IN 47660 �0?3 0--
Country Country /
US G/BSO
AO,
L^ Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those tfirat apply:
01 YES NO CONDITION YES NO CONDITION
1 . ® 0 1.Will this property be the buyer's primary NI 0 3. Homestead
Lo residence? 0 ® 4.Solar Energy Heating or Cooling System
O i
��' 0 2. Does the buyer have a homestead to be vacated 0 al 5.Wind Power Device
• for this residence? If yes, provide address: 0 ® 6. Hydroelectric Power Device
�. Address(number aann t )S 0 0 7. Geothermal Energy Heating or Cooling Device •
C y,State,and ZIP Code County
I , 1" O-, — --)n .• ?r, 1(a -IQ -,, ( -000 .663 - oo- -
N Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,.Is true;correct,and complete
1 ' as required by law,and is prepared in accordance with IC;6-1.1-5.5.A person who knowingly and falsifies the value of
0-� transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
•information,SSN/Driver's License/!D/Other Number is necessary only if a Homestead Deduction is being filed.)
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