Homestead_Ferguson (2) 6 H. PREPARER _
Preparer of the Sales Disclosure Form Title 6
Milton Norman __ _ Settlement Agent -_
Company
Address (number and street, city, state, country, and ZIP Code) l
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
I. SELLER(S)IGRANTOR(S)
Seller 1 - 'arne as it appears on conveyan document Seller 2 - Name as anoears on conveyance document
\Ft. . c,s-_ _4,,ye 'ter-t- ert f \1�t:. N
Address (number and street) ,i �Acaress (number and street) ;
500 S Center St 500 S Center St �.
City, State, and ZIP Code City, State, and ZIP Code
Francisco, IN 47649 I Francisco, IN 47649 j
Country t Country
US Us c
Email Address TelephoneTelenone
Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete as I
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, co its a el 5 felony.
Signature of Seller Signatu. r
Printed Name of Seller Date Signed (mmidd/yyyy) Printed e of Seller Date Signed (mm/dd/yyyy)
S -• el \(v �f ic1loia0)S L , / CIloi.) v:,n-
J. BUYER(S)/GRANTEE(S) -- APPLICATION FOR PROPERTY TAX DEDUCTIONS — IDENTI - L T Y
Buyer 1 - Name as it appears on conveyance document Buyer 2 - Name as it appears on conveyance •
Isaak V. Ferguson OCT - a
Address (number and street) Address (number and street) e 0 20
102 N 4th St . -
City, State, and ZIP Code City, State, and ZIP • •
S•
•
Francisco, IN 47649 M ro ,
Country Country N/I,
Al vQl�
US _ Q
Email Address
1 ( )
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 1 YES NO CONDITION
1. Will this property be the buyer's primary X E 3. Homestead
® residence? [I] ® 4. Solar Energy Heating or Cooling System
T
2. Does the buyer have a homestead to be vacated C M 5. Wind Power Device
O for this residence? If yes, provide address: 0 50 6. Hydroelectric Power Device
Address (number and street) 0 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County r _ 1
Ip L.1- - ` 0 3 - O 0 0 ,-_ 3 _ OO --
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Under penalties of perjury, I hereby certify that this Sates Disclosure, to the best of my knowledge and belief, is true, correct, and complete
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