Homestead_Beard H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street, city, state,country, and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance do ent
ESTATE OF DELORES IRENE WALLIS, deceased k
�
Address(number and street) Address(number and street)
tyrState,and` ZIP Code In\ 4 C7 V/,\ City,State,and ZIP Code �9 �/�
l � �' t I v l v 4, C
,46
Country Countr
y Cie ��O
Gti
Under penalties of perjury, I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,*� and complete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifie 4 1",: e of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. �9
ature of Seller Signature of Seller
1 a 131 aoa
Printed Name of Seller D e ' ed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
BRENDA L.DOMINGUEZ, Personal Repr December 12, 2023 December 12, 2023
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 it appears on conveyance document
RANDY G. BEARD TIFFANY BEARD
Address(number and street) Address(number and street)
5664 S 100 East 5664 S 100 East
City,State,and ZIP Code City,State,and ZIP Code
Princeton, IN 47670-9228 Princeton, IN 47670-9228
Country Country
E-mail Address
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
2( ❑ 1.Will this property be the buyer's primary ❑ 3. Homestead
residence? ❑ Er 4.Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated ❑ g5.Wind Power Device
❑ for this residence? If yes, provide address: ❑ 6. Hydroelectric Power Device
rAess(number and street)
A ❑ 7.Geothermal Energy Heating or Cooling Device
Ci ,State,ZIP code,and County
on t ' ' v 41 V1_ -9 - 0S - 2,06 - 0d2- . 1ct3 -02
Under p nalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
Page 3