Homestead_Campbell H,;P:REP:ARER `
Pre1`r of Sales Disclosure Perm Title lam,0ir
Company
Address.(number and street,city,state;country,and.ZIP Code) •
7820 Eagle Crest Blvd Ste 201,Evansville,IN 47715
I. SELLER(S)YQRANTDR(S)' • :,• : • • • • ... .
Seller I—Name as it appears on conveyance document. Seller.Z.—Name as'appears on conveyance document
Estate of Paula S.Thurston •
Address(Minter and str •U � /J Address(number and street)
City,state,and ZIP Code City,state,and ZIP Code
Country Country
E-mail address Telephone number E-mail address Telephone ilunibei
Under peneltes:otperjury,.Iher'ebycertifythis..Saies.DisclosUre of'tile'besttofmy'.knowledgeand_belief,,is.,true;.Correctand.completeas
required by law;:and is prepared in:accordance with;IC.6-1,1-5c5 A person who-knowinnly:and Intentionally faisifies the value of;transferred.
real property;er..emits or:falsifles any.inrormatlon'.requiredao:be.provldeti,:commitsa Level 6;fetony. • • '• .. •
signature of Seller $ign elute.of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mmldd/yyyy)
Estate of Paula S.Thurston 01/29/21 01/29/21
J,:BUYER.(S)/GRANTEE(s).--APPLICATION FOR PROPERTY,TAX DEDUCTIONS iDE.NTIFY•ALL THAT APPLY • '
Buyer 1-Name as it appears en:conveyance document Buyer 2—Name as it appears on conveyance document.
Jackie Campbell
Address(number and street) Address(number and.street)
tZ O2 Pant. Pic.
City,state,aode, , 1./ n u I City,state,and ZIP Code •
Country USA l Country
E-mall address.
Pursuant to iC 444-12.44,the Sales.Disclosure Form may`be:used to:apply for certain deductions,identify all of those that'appdyt, .o
YES NQ CONDITION YES NO CONDITION Ed
0 3.Homestead cn
o n
O 1.Will this property be the buyer`s primaryZ ' ;.
reSIdence?' 0 4.Solar Energy.Heating or Cooling Systems H
,--, )qd 2,Does the buyer have a homestead•to be vacated D x, 1.Wind Power Device z v
for this residence?If yes,provide address: 0 0 .6.Hydroelectric Power Device
c d
Address(nurriber and street)" 0 7,Geothermal Energy.Heating or•Cooling
O
City,state;and ZIP Code County 26-12-17-101-000.820-028 x .
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