Homestead_Michel H. PREPARER
Preparer of the Sales Disclosure Form Title
AMIE MASLANKA Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
5231 Oak Grove Road,Suite A,Evansville,IN 47715 j: j-_j ,,1I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
The Carl R.Michel Revocable Living Trust dated July 15,2015 OCT
Address(number a d treet) r,
d " ����
L4 I L' f I S r. Address(number and street) ( (Same
City,state,an P ode (� cam.,. �—A
� �ILA V fi I( sue+J. '3/p 4 City,state,and ZIP Code GIB"refrr�t ,f�,l/i �1,3
Country Country j AUDITOR
United States of America United States of America
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 Intentionally falsifies the value of transferred
real property,or omits or f ties a ' form ozirtquired to be provided,commits a Level 5 felony. /tl�� Sl
n Lure o!Sailer re of Sel
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Printed Name of Seller t Date si (mml dlyyyy) Printed Name of 1Seler ( Date sign (mm/d /yyyy)
Karen Kay Richardson t O/- / ,e .3 '��.A—e- �. 1 CM L D/'Z,'�j L'Z.0-1:j
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 appears on conveyance document
John A.Michel Abby M.Michel
Address(number and street) Address(number and street)
5077 East 825 South 5077 East 825 South
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch,IN 47648 Fort Branch.IN 47648
Country I Country
United States of America United States of America
YES NO CONDITION 7YES. NO CONDITION
❑ 1.Will this property be the buyer's primary residence? 0 3. Homestead
0 0 4.Solar Energy Heating or Cooling System
❑ 2.Does the buyer have a homestead to be vacated for El 0 5.Wind Power Device
this residence? If yes,provide address: ❑ El 6. Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
ZC — lc(-2_(] -Loa - oOO . 1-pis—
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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