Homestead_Dills H. PREPARER
Preparer of the Sales
'Dii Iossurrye�Form/f �/j Title
✓Wt/d Ul /l COY Title Company
Company
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears •.'( onv�a e do m n
Shelby L.Seramur
Address(number and street) Address(number and street)
531 Sherman Street NO v1
City,State,and ZIP Code City,Slate,and ZIP Code ! 4 2024
Oakland City,IN 47660
Country Country
US Gi8SON con
Email Address
•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.
Signat a of Se)ler - Signature of Seller
Printed Name of Iler Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/ddlyyyy)
Shelby L.Seramur I0/18/2024 J 10/18/2024
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
Melinda G.Dills
Address(number and street) Address(number and street)
106 W Brummitt St Ar
05-
City,State,and ZIP Code City,State,and ZIP Code s;.K
Owensville,IN 47665 . tiff
Country Country
US
F rm may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION ES NO CONDITION
1.Will this property be the buyer's primary 3.Homestead
residence? ® 4.Solar Energy Heating or Cooling System
CT for
Does the buyer have a homestead to be vacated 0 2) 5.Wind Power Device
for this residence? If yes,provide address: 0 NJ 6.Hydroelectric Power Device
Address(number and street) 0 ® 7. Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County q/ _ 1 I _vs_ °0 0 -736^co 0-f
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