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Homestead_Hall (4)
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)/GRANTOR(S) Seller 1—Name as it appears on conveyance document Seller 2—Name as appea •'•n co e ce document Andrew D.Zillak Address(number and street) Address(number and street) ,d r t �7�'1 I�'acytrr,, ��r. 001 :6 City,State,and ZIP Code ` City,State,and IP Code e/ Fort Branch,IN 4764E CI: gr- a, .-4L4 5� .�Q1# Country Country (4/eS0 US Email Address knowledge and belief,Is WO,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 /' P -�//Z' Printed.mil Name of Seiler Da Sig ed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy) Andrew D.Zillak i Oi; 7/7_•••z-'i - 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 Jennifer D.Hall Steven B.Hall Address(number and street) Address(number and street) I5 Oct e c-AcOs [ :Same City,State,and ZIP Code //�� City,State,and ZIP Code {rt r-\ �7S-r/�C,n trt.-3 t e,i.te•. - 1 Country Country , rNl US US O C!� YES NO CONDITION YES NO CONDITION N ® 1.Will this property be the buyer's primary 1) 0 3.Homestead Ciop residence? 0 0 4.Solar Energy Heating or Cooling System 2.Does the buyer have a homestead to be vacated 0 0 5.Wind Power Device 9 i for this residence?If yes,provide address: 0 0 6.Hydroelectric Power Device O Q Address(number and street) 0 ® 7.Geothermal Energy Heating or Cooling Device (f� i©zeb CL ( L 65'; r. City,State,and ZIP Code County i Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct,and complete p© 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 —TA transferred real property,or omits or falsifies any Information required to be provided,commits a Level 5 felony.(Note:Both spouse's information,SSN/Driver's License/ID/Other Number is necessary only If a Homestead Deduction is being filed.) N Page 3 iI y. 'T (1..)\---) . a