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Homestead_Campbell (6)
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 o ance document Elizabeth Ann Mercer l/vr Address(number and street) Address(number and street) WI N • PoiK- S.t. City, and ZIP Code Lp '' Y City,state,and ZIP Code Fort f rancK, I(1 L-r11.Du 4 &CT / [+ Country Country v �14 US US hereby certify this Sales Disclosure,to the best of my knowledge and belief,i t ct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally false atlhe value of transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.Siture of Sell r Signature of Seller .t Ali 4b /i/ '1 ,ø7T Printed Name o Seller Dat•sig ed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy) Elizabeth Ann Mercer by Daniel D.Mercer AIF 10/8/20204 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 Sherry Campbell Address(number and street) Address(number and street) 104 South Church Street City,state,and ZIP Code City,state,and ZIP Code Fort Branch, IN 47648 Country Country US US apply for certain deductions.Identify all of those that apply: YES NO CONDITION YES NO CONDITION O O 1.Will this property be the buyer's primary O 0 3. Homestead residence? 0 0 4. Solar Energy Heating or Cooling System O • 2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device for this residence?If yes,provide address: D 0 6. Hydroelectric Power Device Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device City,state,ZIP code,and county '2 lq— IS 3n3 _ ©o o. Glut o— 026. Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete Cl