Homestead_Englehardt H. PREPARER
Preparer of the Sales Disclosure Form Title
Kandace Rogers Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on nv n doc nt
Nicholas Sellers
Address(number and street) Address(number and street)
2509 E Classic Dr 406 14fir
City,State,and ZIP Code City,State,and ZIP ode 201
Haubstadt, IN 47648
Country Country QI
USA ‘304,
CO (2
'IUD/8212,r/
Under penalties of perjury,I hereby certify 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.
Signature of Seller Signature of Seller
j
minted Nine drg- -eitIeFZ- -- Date Signed(mrnicid6ryyyj Printed Name of Seller I Date Signed(mm/dd/yyyy)
Nicholas Sellers 08/23/2024 08/23/2024
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
Christy M. Englehardt
Address(number and street) Address(number and street)
703 Tretter Park Drive
City,State,and ZIP Code City,State,and ZIP Code
Fort Branch, IN 47648
Country Country
USA
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
r--1 1.Will this property be the buyer's primary C 3. Homestead
k-1 residence? [11 I
[1] 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated El CI
5.Wind Power Device
for this residence? If yes,provide address:
N 6. Hydroelectric Power Device
Address(number and street) 7. Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and County -161 - 3°2- 000. 6232_ —02-6
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