Homestead_Nilges H. PREPARER
Preparer of the Sales Disclosure Form Title
Kris Coon Closing Agent
Company
Address(number and street,city,state, country,and ZIP Code)
4600 Washington Ave., Suite 102, Evansville, IN 47714
I. SELLER(S)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on n y c ocument
Jeffrey L. Haggard
45$( beKty s t i, Arc) Address(number and street) 4
/1/ '40)
ly,statat,tanIP1 de 14m 0 City,state,and ZI• ...e 4.
C u �V��an�V\• N Country �'r�S'O•
• 4
� J 1`� CIoGQ
knowingly and intentionally faai tifies the value of transferred
real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.
Si lu of Seller Signature of Seller
P n m 1K••i ler Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Jeffrey L. aggard (424qy
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
Samantha R. Nilges Dustin R. Nilges
idotn r n l 1.S Address(number and street)
(
Vitt1,20
"`r tC k i C l 8 5 City,state,asK
Country
YES ,NO CONDITION YES O CONDITION
�1J//J❑ 1.Will this property be the buyers primary ' 0 3. Homestead
residence? ❑ 4.Solar Energy Heating or Cooling System
❑ X. 2.Does the buyer have a homestead to be vacated 5.Wind Power Device
for this residence?If yes,provide address: 0 6. Hydroelectric Power Device
Address(number and street) 0 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county /`
,b- - 1 3o 3 -0o o . i oo - 0Z4
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my 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 falsifies any information required to be provided,commits a Level 5 felony.(Note:Both spouse's
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