Homestead_Rich (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Natalie Foley Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
25 NW Riverside Drive,Suite 310,Evansville,IN 47708 _�j ,
I. SELLERS)/GRANTOR(S) •
Seller 1-Name as It appears on conveyance document Seller 2-Name as aags dh conveyance document
Steven B.Hall Jennifer D.Hall C / 2Q211
Address(number and street) Address(n er and street)
. 5.1754 e_ 1kc)5s Sam ,.., A�
City,State,and ZIP Code %CJ. 1.-thrry A'246;i2.1.) C))
City,State, X,r� .P -
Country Country vO1TpR
US US
Email Address
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 falsities any information required to be provided,commits a Level 5 felony.
Sign of Seller I g ign re of Se
Pnn d Name of Seller • Date Signed(mm/ddtyyyy) Printed,Name o Iler- '— Date Signed(mm/dd/yyyy)
Steven B.Hall to /i 7 /ZLI Jennifer D.Hall WI 1-7 I72r'2.`4:
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
Randall Rich Teresa Rich
Address(number and street) Address(number and street)
10206 S Quail Crossing 10206 S Quail Crossing
City,State,and ZIP Code City,State,and ZIP Code
Haubstadt,IN 47639 Haubstadt,iN 47639
Country Country •
US US
Email Address
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
IN1.Will this property be the buyer's primary CD 3.Homestead
residence? p ►:4 4.Solar Energy Heating or Cooling System
® 2.Does the buyer have a homestead to be vacated D GO5.Wind Power Device
for this residence?If yes,provide address: 0 ® 6.Hydroelectric Power Device
Address} l�J
(numbJeran�'ijtreet) �j 0 IX 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County
Under penalties of perjury,I hereby certify that 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
e ,11 -..31