Homestead_Blythe H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers 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
Gary D.West Julie L.West
Address(number and street) Address(number and street)
12733 S 40 W 12733 S 40 W
City, State and ZIP Code City,State and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
Country Country
United States of America United States of America
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 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
roperty,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Si ture of Seller r\ ature of,Seller
Printed Na el Date signed(mm/dd/yyyy) Printed Name of II r Date signed(mm/dd/yyyy)
Gary D. t 11/19/2021 Julie L.West 111/19/2021
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APf
Buyer 1 -Name as it appears'on conveyance document Buyer 2-Name as it appears on c v y c do u t
Timothy W. Blythe Cheryl J. Blythe
VAddress(number and street) Address(number and street) NOV 2 4 2021
1100 Hoing Rd 1100 Hoing Rd
M
_ City,State and ZIP Code City,State and ZIP Code q- �
? Evansville, IN 47725 ki-e--la,i�Q. 1,
Evansville, IN 47725 CountryGIBSON COUNTY AUDITOR
� Country
cUnited States of America United States of America
<
I 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
Ls" ID 1. Will this property be the buyers primary residence? 0 3. Homestead
` 0 p 4, Solar Energy Heating or Cooling System
Qo 0 2. Does the buyer have a homestead to be vacated for this 0 ll 5. Wind Power Device
residence? If yes,provide address:
l 0 l 6. Hydroelectric Power Device
A d ess umbe Vf
rid treet) 0 0 7. Geothermal Energy Heating or Cooling Device
C' State,and ZIP Code ou ty
cNi S°vAU i ‘At LA-- 7,5 VQn r,. V- _ 6-2-3 -13 -So0-ooO. 012) - 02,Li.
Under penalties of perjury, I hereby certify that this Sales Disclosur ,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.)