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Homestead_Cruz
H. PREPARER Preparer of the Sales Disclosure Form Title Jan-le E Smith Escrow Officer 1 Conlparty Address(number and street,dty,state,country,and ZIP Code) 101 Plaza E Boulevard,Suite 102, Evansville, IN 47715 I. SELLER($)/GRANTOR(S) XI c�-Name ap d appeaarrs n conveyance document Seller 2-Name as appears on conveyaPmf en J4R ri tL.drtilt' 1 Address(number and ess(umber a d treet) street) /,(I� --b ` b N �d��(1 Si • iS City � �C and�ZIP�Code`_Iv 4 �� City.Slate.and ZIP Codes �02� ir\ Oaur try Country ON C tl ,, Email Address ` my knowledge and belief,is true,correct,and complete as requ red 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. _ - Si <dure of Seller i . Signature of Seller ce tinted a ell Dale jg epp erld/yyyy) Printed Name of Seller Date Signed(mmlddyyyy) ti \tf\_ l..eoft p�( EEt LILIJ J. BUYE {S)/GRANTEE S)-APPLIC ION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY u er 1-Na as it ears on conveyance document Buyer 2-Name as it appears on cony ance document Ftl f t ot,0 a A • CiAr - gddre ( era d street) Address(number and street) g'L��7 N al Vl 51'V-Pe} d) 6ily 'irate,and ZIPde City,State,and ZIP Code p1L\Y\c(4CAW 471p Cory Country Email Address certain deductions.Identify all se that apply: YES ..„.NO CONDITION YEE,S,//NO CONDITION (i ❑ 1.Will this property be the buyer's primary �d' 0 3.Homestead res dence? 0 Q 4.Solar Energy Heating or Coo n yste 2.Does the buyer have a homestead to be vacated ❑ 0 5.Wind Power Device ❑ for this residence?If yes,provide address: o © 6.Hydroelectric Power Device Address(number and street) 0 CO 7.Geothermal Energy Heating or Cooling DevIce City,State,and ZIP Code COunly 24 \2,-,-0-1 102-- Oo\ .00 1 -02-g .