Homestead_Allen (4) H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Andrew D. Hagen
Address(number and street) Address(number and street)
8737 South Meadow Lane
City,State,and ZIP Code City,State,and ZIP Code
Owensville, IN 47665
Country Country
E-mail Address
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 eller Signature of Seller
'Printed Name of Seller Date Signed(mm/dd/yyyy) Printed Name of Seller Date Signed(mm/dd/yyyy)
Andrew D.Hagen August 8, 2025 August 8,2025
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-I NT Y LL ,r cT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on con r-' • c
Austin M.Allen Address(number and street) Address(number and stree�v1`
&' J
8737 South Meadow Lane ' 2025.
City,State,and ZIP Code City,State,and
Owensville, IN 47665 &sr,
Country Country (/N 1�,`�`
E-mail Address
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
❑ 1.Will this property be the buyer's primary ❑ 3.Homestead
residence? ❑ E 4.Solar Energy Heating or Cooling System
-/2.Does the buyer have a homestead to be vacated ❑ LQ 5.Wind Power Device
❑ for this residence? If yes,provide address: ❑ 6.Hydroelectric Power Device
Address(number and street) 7.Geothermal Energy
Heating or Cooling Device
City,State,ZIP code,and County Zq-(00-C7(7L{•-716- 02-( .
ter`.
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