Homestead_Staley 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 nce document
Household Thoughts, LLC
d umber a e Address(number and street)
aLA ie i �C b
C an ZIP od 1441
/� rR )nCity,state,and ZIP Code ce O�}l I Cf _ o,¢
Co ntrj Country L ��
G/eSC
best of my knowledge and belief,is rarporrect 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.
Signature of Seller Signature of Seller
Printed Name of Seller ' Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mrn/dd/yyyy)
Brian Ellis f, 3/ . y
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
Steven Staley
Sass •07501-)irt) Address(number and street)
d ZIP ..a City,state,and ZIP Code
illitco
C un Country
certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1,, Ni21.Will this property be the buyer's primary O 3. Homestead
CJ residence? p 4. Solar Energy Heating or Cooling System
o 2. Does the buyer have a homestead to be vacated � 5.Wind Power Device
iO for this residence? If yes, provide address: 0 6. Hydroelectric Power Device
O Admv an eet)b 0 X 7.Geothermal Energy Heating or Cooling Device
C . Zwr IN 4,.. l0\,0� . -1u - 6 -101 -0oo. 34-1- oo4-
Under penalties of perjury,I hcheK certifythat this Sales Disclosure,to the best of myknowledge and belief,is true,correct and complete
y k edg a ef, p
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
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