Homestead_Hart {
H. PREPARER
.____. ----i
Preparer of the Sales Disclosure Form Title
Kelly Norton Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
1. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
JASON J. GRABER
Address(number and street) Address(number and street)
City,state,and ZIP Code City,state,and ZIP Code
-
Country Country
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 property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Si ture of Seller Signature
Signature of Seller
PrintedNarr of Shc VCII Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
JASON J.GRABER November 30, 2021 November 30, 2021
J. BUYER(S)/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
JUSTIN W. HART
Address(number and street) Address(number and street)
619 North Polk St
City,state,and ZIP Code City,state,and ZIP Code
Oakland City, IN 47660
Country Country
certain deductions.Identify all of those that apply:
YES f NO CONDITION YES NO CONDITION m
�,/ ❑ 1.Will this property be the buys primary 0 3.Homestead z a
LIIJ residence? oy�; ❑ ur 4.Solar Energy Heating or Cooling Sy CD o H
5.Wind Power Device c o'
2.Does the buyer hayikRttomestead to be vacated ❑ czs N
❑ for this residence?It tp s, provide address: ❑ Hydroelectric Power Device
Address(number and street) ycs 0 L.7 r.Geothermal Energy Heating or Cool4 ice d
ors
City state, f2d ZI'Code 4i�' County 26-14-18-203-000.867-007 xi
Pantgg aIN 4 c� L308 errN) n Ave co
E Ville IN 47/11.. . Per NJ not c aiming Hstead (state Data )ase) co
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
1 1