Homestead_Livermore (6) 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. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Daryl R. Lanham
Address(number and street) Address(number and street)
9950 Saint Lawrence Spur
City,state,and ZIP Code City,state,and ZIP Code
Philpot, KY42366
Country Country
USA
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.
Signature of Sell r Signature of Seller
Printed Name of Seller Date signed mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Daryl R. Lanham
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTI LI AP
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance die
Scott Allen Livermore /'
Address(number and street) Address(number and street) JON ...1 J
1001 East Broadway Street 202i
City,state,and ZIP Code City,state,and ZIP Code .
Princeton, IN 47670 63
Country Country SO�CQ Q '/
USA UNhy`�'4
for certain deductions.Identify all of those that apply:
YES /NO CONDITION YES O CONDITION
>�// 1.Will this property be the buyers primary tO 3.Homestead
residence? 0 4._. 4.Solar Energy Heating or Cooling System
O A2.Does the buyer have a homestead to be vacated 0 " 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-I Z-C7 31 -Go1 . 6 s-- o 2_1