Homestead_Coomer H. PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman r Settlement Agent
Company E-mail address
Address(number and street,city,state,country, and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708
f. SELLER(S)IGRANTOR(S) J �
Seller 1-Name as it appears on conveyance document Seller 2�-Name as appears on conve 'men
James E.Powell,IV , Lindsey N.Short
Address(number ind stye. j Address(number and street)
Oily,state,and 7T1P Code ,, _ •• City,stave,and ZIP Code 3
i Q (- ��< ,L i ' L kks :>`� ;s __ —
Country t Country G/B'JONC_
US US °U/ I,
E-mail address
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 orfaisiiles any information required to be provided,commits a Level 5 felony.
Sub nature of Seller 1.$ygnatuse of$ lle5c4 n, A
: l f tit F i , , it .-1-/ $ ,, i , t S ;•jr•,,' -!
Printed Name of Seiler Date sigred(mni/dd y yy) Printed Na e,4 eger i Date'ei (mrnldd yy)
James E.Powell,IV I 1—9 ..--'2 Lindsey N.Short +
J. BUYER(S}IGRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY •
Buyer 1-Name as it appears an conveyance document Buyer 2-Name as it appears on conveyance document
I Kelsie Coomer
Address(number and street) Address(number and street)
228 South Lucretia Street
City,state.and ZIP Code City,state,and ZIP Code
Oakland City,IN 47660
Country Country
US
E-mail address
apply for certain deductions.Identify all of those that:••1 :
YES NO CONDITION YES NO CONDITION
® O 3. Will this property be the buyer's primary OD O 3.Homestead
residence? ® ® 4. Solar Energy Heating or Cooling System
O 2, Does the buyer have a homestead to be vacated 0 ® 5.Wind Power Device
c? 1
. for this residence? If yes,provide address: O 6. Hydroelectric Power Device
Y
Address(number and street) 0 ® 7.Geothermal Energy Heating or Cooling Device
.
City,state.ZIP code,and county ll//d�'-1 I� --IDS -K03 - 000 .0S z_
Under penalties of perjury,I hereby certify that this Sates Disclosure,to the best of my knowledge and belief,is true,correct and complete
3 of 5