Homestead_Ray H. PREPARER
Preparer of the Sales Disclosure Form Title
Milton Norman Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
25 NW Riverside Drive,Suite 310, Evansville, IN 47708
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Braunson T. Mizeur
Address(number and street) Address(number and street) ,P,44
9376 E300S Road
City,State,and ZIP Code City,State,and ZIP Code
Oakland City, IN 47660 /ylQ `0)4
Country Country ^1,/
US G% 0
Email Address Address 'SO Telephone Number
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and bell r
-1 rrect,and complete as
required by law,and is prepared In accordance with IC 6-1.1-5.5.A person who knowingly and intentional(}i a value of transferred
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. OR r
Signature of Seller Signature of Seller �I
Printed Name of Seller Date i ned(fnm/ddjyyyy) Printed Name of Seller Date S red(m dd/yyyy)
Braunson T.Mizeur /54)-4-1
)-
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
Sebastian Ray
Address(number and street) Address(number and street)
5710 S 6th Street
City,State,and ZIP Code City,State,and ZIP Code
Vincennes, IN 47591
Country Country
US
Email Address
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
011 1.Will this property be the buyer's primary ( 0 3. Homestead
residence? 0 ® 4. Solar Energy Heating or Cooling System
0 C 2. Does the buyer have a homestead to be vacated 0 ® 5.Wind Power Device
for this residence? If yes, provide address: 0 1 6. Hydroelectric Power Device
Address(number and street) 0 ® 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County y 554 _ ouG
a� �I � '2�- ZOo- 000 . O
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief, is true,correct,and complete
3