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Homestead_Johnson (5)
H. PREPARER Preparer of the Sales Disclosure Form Title Matthew Jarvis Escrow Officer Company Address(number and street, city, state, country, and ZIP code) 605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713 I. SELLER(S)/GRANTOR(S) Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears on conveyance document Charles R.Johnson Address(number and street) Address (number and street) 405 E Warrick St. City, State and ZIP Code City, State and ZIP Code Owensville, IN 47665 Country Country United States of America Email Address Under penalties of perjury,I 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 o its or f I ifies any information required to be provided, commits a Level 5 felony. Sig o ler Signature of Seller Printed Na re of Iler Date Sign d (m /dd/ Printed Name of Seller Date Signed (mm/dd/yyyy) Charles R. Johnson YYYY))07 (25 wit /GRANTEE S —APPLICATION FORU PROPERTY TAX DEDUCTIONS—IDENTIFY ALL LY J. BUYER(S) ( ) ...� Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on conveyanc Raquel Johnson AUG 0 Address (number and street) Address (number and st t) .2 2024 405 W Warrick St %� if - City, State and ZIP Code City, State and ZIP Code s'ON OUNy �Owensville, IN 47665 , fTOR Country Country United States of America 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 El 0 1. Will this property be the buyer's primary residence? 0 0 3. Homestead ❑ El 4. Solar Energy Heating or Cooling System 0 El 2. Does the buyer have a homestead to be vacated for 0 p 5. Wind Power Device this residence? If yes, provide address: 0 RI 6, Hydroelectric Power Device Address (number and street) ❑ © 7. Geothermal Energy Heating or Cooling Device City, State, and ZIP Code County ` _ L p Under 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 transferred real property, or omits or falsifies any information required to be provided,commits a Level 5 felony. (Note:Both spouse's information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.) sig Lure of Buyer Signature of Buyer 2/Spouse Printed Le al Name of Bu er 1 Sign Date(MM/DD/YY) Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YY) Raquel Johnson 7/26/2024