Homestead_Emmett (2) H.�,-PREPARER
Preparer of the Sales Disclosure Form Title"
J. Robert Kinkle Attorney
Company
Address(number and street,city,state,country,and ZIP Code)
219 N. Hart Street, Princeton, IN 47670
I. SELLERS)/GRANTOR(S) ,
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Roger Dale Jackson Shanna C. Jackson a/k/a Shanna K. Jackson
Address(number and street) Address(number and street)
1702 Cottonwood Drive 1702 Cottonwood Drive
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country Country
USA USA
E-mail address __E-mail 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 bylaw,and is prepared m accordance with IC 6 1s1=5 5 A person who knowingly and Intentionally;falsifies:the value oftransferred
real property,or.omits;or,falsifies any information required to"be provided,'com its a Level'5 felony: 3'_ i
Signature o eller Signat of Seller
Printed Name o Sel er Date signed /dd/ Printed Name of Seller Date signed(mm/dd/yyyy)
( YYYY) 9 ( YYYY)
Roger Dale Jackson 2/19/2021 Shanna C.Jackson a/k/a Shanna K.Jackson 2/19/2021
J; BUYERS)/GRANTEE(S) APPLICATION.FOR PROPERTY TAX DEDUCTIONS IDENTIFY ALL THAT APPLY
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance document -
Jessy R. Emmett
Address(number and street) Address(number and street)IL D
9 Yost Court, Apt. 6
City,state,and ZIP Code City,state,and ZIP Code
Lawrenceville, IL 62439 FEB 23 2021
Country Country
USA I�1,2cittau.'
GIBSON cOUN1 ( '
Pursuantto;IC 6 1 1,=12-44,,the Sales Disclosure Form maybe used;to apply for certain deductions;Identify:all of those that apply:.
YES NO CONDITION YES NO CONDITION
O 1.Will this property be the buyer's primary G6 0 3. Homestead
residence? 0 CO 4. Solar Energy Heating or Cooling System
O O 2. Does the buyer have a homestead to be vacated 0 l� 5.Wind Power Device
for this residence? If yes, provide address: 0 g 6. Hydroelectric Power Device
Address(number and street) 0 RI 7. Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
2 6�\2-^.0 6--LI-ot -oat . 2 ,, --
Last 5 Digits of Buyer 2/Spouse SSN/Driver's License/ID/Other Number
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