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H. PREPARER
Preparer of the Sales Disclosure Form ' Title
Stacy Brown closing agent
Company
Address (number and street, city, state, country, and ZIP Code) —
4600 Washington Ave Suite 102, Evansville. IN 47714
I. SELLER(S)IGRANTOR(S)
Seller 1 -- Name as it appears on conveyance document I Seller 2 — Name as appears on conveyance document
Makayla Nicole Loeffler Quentin Robert Hale
Address (number and street) Address (number and street)
701 Applewood Road
City, State, and ZIP Code City, State, and ZIP Cga 4.e_
Huntingburg, IN 47542
Country Country _
Email Address m: 6
)
Under penalties of perjury, 1 hereby certify this Sales Disclosure, to the best 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 of Seller � ��1 Signature of S
Printed Name of safer Dale Signed (rnm/dd/yyyy) Printed Nam f Seller D e Si d (r n/ d/yyyy)
Makayla Nicole Loeffler 1 G 1 L9 Quentin Robert Hale �o(
J. BUYER(S)IGRANTEE(S) — APPLICATION FOR PROPERTY TAX DEDUCTIONS I A APPLY
Buyer 1 - Name as it appears on conveyance document Buyer 2 — Name as it a ars nve d t
Erik Tony Hernandez
r_
Address (number and street) Address (number and street) f
121 W Mulberry St i�A /� e j
City, State, and ZIP Code City, State, and ZIP Code 2t1�U 1
3
Princeton, IN 47670
Country Country
a
Email 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
V0 1. Will this property be the buyers primary 3. Homestead
residence? 0 2 4, Solar Energy Heating or Cooling System
V2. Does the buyer have a homestead to be vacated ❑ O 5. Wind Power Device
for this residence? If yes, provide address 0 ❑r 6. Hydroelectric Power Device
Address (number and street) C) Q 7. Geothermal Energy Heating or Cooling Device
City, State, and ZIP Code County 0 —
G 4 _ 01 o _ 02-a
, .
rUnder penalties of perjury, I hereby certify that this Sales Disclosure, to the best 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
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