Homestead_Ambrose H. PREPARER __'
Preparer of the Sales Disclosure Form r Title • i
Amy B.Perkins Settlement Agent I
Company
it
Address(number and street,city,state,country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715 I
I. SELLER(S)/GRANTOR(S) C
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document /
Amy Michelle Green,incorrectly identified as Amy Michelle Green f
Address(number and street) Address(number and street) .1 l
106 E Vine Street
City,State,and ZIP Code City,State,and ZIP Code
Country Patoka,IN 47666 41) i
Country /�Country �/ O,
US ?�nj
besq of my knowledge and bci{�f'I ,correct,and complete as
required by law,and Is prepared in accordance with IC 6-1.1-5.5.A personWho knowingly and intention ' s the value of transferred u
rea roperty,or omits or falsifies any tylformation required to be provided,commits a Level 5 felony. — Qi?.,
Sian lure
to}f!Sell r 9/� I {� l`�' p, ,, Signature of Seller R E!
U kA 1 k ll .1k(l VQ 1) QJv__Q t
PA'ed Nartg)ot'Seller Date Signed(mmldd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy) `
Amy Michelle Green,incorrectly Identifie 05/02/2025 05/02/2025
J. BUYERS)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY t
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance document
Toby J.Ambrose f
Address(number and street) Address(number and street) I
1A nC Her-- Si-•
City,State,and ZIP Code City,State,and ZIP Code
Country Country
for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
® 1.Will this property be the buyer's primary ® 0 3. Homestead
residence? 0 2 4.Solar Energy Heating or Cooling System
0 i.� 2.Does the buyer have a homestead to be vacated 0 1. 5.Wind Power Device
for this residence?If yes,provide address: 0 ® 6. Hydroelectric Power Device
Address(number and street) 0 1i 7.Geothermal Energy Heating or Cooling Device
City,State,and ZIP Code County 4q.
6'' O (-1^ 21‘ -30y- coo. 2.-61 ^020 .
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct,and complete 1
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