Homestead_Cox (3) 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. SELLER(S)IGRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Andrew Lee Anderson Jamie Lynn Anderson
Address(number and street) Address(number and street)
204 N 3rd Street 204 N 3rd Street
City,State,and ZIP Code City,State,and ZIP Code
Owensville,IN 47665 Owensville,IN 47665
Country Country
US US
Email Address
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 onor:falsifies any Information required to be provided,commits a Level 5 felony.
Signature of Sel{rrr" JI 1 i"hr
of Sea1e1, � h (,�1�'}�i°���� !�n�r)
e �. if }L
' Printed Nam ' Seller � ` Date Signed(mmldd/yyyy) Minted N JoT e �� Date igned(mrnldd/yyyy)
•
Andrew Lee Anderson .. x L Jamie Ly n e on X- �N-kJ
J.-BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTION ALL THAT APPLY f
Buyer 1-Name as it appears on conveyance document Buyer 2-I �s it appears on conveyance document
Dalton J.Cox Faith A.Cox U 4 20,
Address(number and street) ss(number and street)
• 151 S.Sharp St G/
City,State,and ZIP Code City,
A.aQ0 R�i ede
Poseyville,IN 47633 Poseyville,I 47 �n J \J
Country Country /TuR
US US
Email Address
YES NO CONDITION YES NO CONDITION
631 1.Will this property be the buyer's primary al 0 3. Homestead
residence? 0 ( 4.Solar Energy Heating or Cooling System
0 2. Does the buyer have a homestead to be vacated 0 (l 5.Wind Power Device
for this residence? If yes,provide address: 0 al 6. Hydroelectric Power Device
Address(number14��streex) 2 r 0 ( 7.Geothermal Energy Heating or Cooling Device'
7 .) .tt-
CIty�tate,and ZIP Co r n County
I-pr; . ndzi /A/ f r �. � ��1- 01 ��-Iv4 -00�. � U��-�G
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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
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