Homestead_Gamble H. PREPARER
Preparer of the Sales Disclosure Form Title
Pamela Partenheimer Mick Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
219 N Hart St, PO Box 13,Princeton, IN 47670
1.SELLER(S)/GRANTER(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
DZW Realty,LLC
Address(number and street) Address(number and street)
235 N Burkhardt
City,state,and ZIP Code City,state,and ZIP Code
Evansville, IN 47715
Coupir1y Country
person who knowingly and intention shies 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/dd/yyyy) Printed Name of Sellerale dd/yyyy)
Wyatt C. Carter, Member 07/31/ , ' �/�n
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIO IDENTIFY T,AT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as0 on conveyance-Kament
Jedidiah P.Gamble S@
Address(number and street) Address(number and stre t)Co,f /
123 E Taylor St �.
City,
star ZIP 47601,and
Code City,state,and ZIP Code I�O/
Cquitry Country
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
O ❑ 1.Will this property be the buyer's primary 0 0 3.Homestead
residence? 0 CI 4.Solar Energy Heating or Cooling System
{,( ❑ 2.Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence?If yes,provide address: 0 CI 6.Hydroelectric Power Device
AI (n be n i6t) 0 p 7.Geothermal Energy Heating or Cooling Device
C' ,state,ZIP code, d county
bnv llt t IN hi01 a(3-1Z- 18-1oz - OO Z. I01— 028
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
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