Homestead_Fireline H. PREPARER
Preparer of the Sales Disclosure Form Title
Allyn Tresenriter Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
7412 Eagle Crest Blvd Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Debra R. Seib
Add ps(numb pnd street)_ Address(number and street)
13a1City,staatt_e,and ZIP Cod Ivy/ City,state,and ZIP Code
Country Country
US US
E-mail address /�
( )
Under penalties of erjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as
required by law,a d 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.
gnature Sell J t Signature of Seller
ted Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date si. :_+ 1ilk/yyyy)
ebra R. Seib 09/26/2024
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTI %, L '+a -•LY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on conv , .nce document t p
Jacob Fireline OZ ZO2'h°l\
Address(number and street) Address(number and street) OC. ✓ `�
11832 South 150 West ,l 4
City,state,and ZIP Code City,state,and ZIP Code Go N=tV P�u��OFZ
Haubstadt, IN 47639
Country Country 0—
US US
CONDITION YES NO CONDITION
0 1.Will this property be the buyer's primary O 0 3. Homestead
r idence? 0 0 4.Solar Energy Heating or Cooling System
0 2. Does the buyer have a homestead to be vacated 0 C) 5.Wind Power Device
for this residence? If yes,provide address: 0 O 6. Hydroelectric Power Device
Address(number and street) 0 Q 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
26- /7---36,—410 -000, 37- Oo q
Last 5 of SSN:
Page 3 of 5