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Homestead_Sellers (2)
H. PREPARER Preparer of the Sales Disclosure Form Title Kandace Rogers Closing Agent Company Address(number and street,city,state,country,and ZIP Code) 4905 Theater Drive, Evansville, IN 47715 I. SELLER(S)/GRANTER(S) 1 Seller 1-Name as it appears on conveyance document Seller 2-Name as appear co a nce d u David N. Becht Constanza R. Becht Address(number and street) Address(number and street) 1384 Eagle Crossing Drive 1384 Eagle Crossing D9 C City,State,and ZIP Code City,State,and ZIP Code .0 2024 Orange Park, FL 32065 Orange Park, F 2065 1 Country Country USA USA Gies Q J AUWrOR 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. Signature of Seller Signature of Seller Printed Name of Seller Date Signed(mm/ddlyyyy) Printed Name of Seller Date Signed(mm/dd/yyyy) David N.Becht Constanza R.Becht 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 Nicholas Sellers Sylvia Sellers - Address(number and street) Address(number and street) , 2509 Classic Drive 2509 Classic Drive ' City,State,and ZIP Code City,State,and ZIP Code ' Haubstadt, IN 47639 Haubstadt, IN 47639 i Country Country F''.• , USA USA " ' for certain deductions.Identify all of those that apply: YES NO CONDITION YES NO CONDITION 0 ❑ 1.Will this property be the buyer's primary ❑X ❑ 3.Homestead residence? 0 4.Solar Energy Heating or Cooling System 2.Does the buyer have a homestead to be vacated ❑ 0 5.Wind Power Device for this residence?If yes,provide address: ❑ 0 6.Hydroelectric Power Device �� Address(numbed and street) r ❑ ❑X 7.Geothermal Energy Heating or Cooling Device 7 City,Stale,ZIP cod County 13 I r�- c ---A) ii?&sic( '2_6— 2 3-)6- 400- o©I - X6,4 —021{ d.J.D,Ieflienalties 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 Page 3 /QN\ • Pug*3 /t((/� (CC�J ,