Homestead_Mallory H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Latham Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave,Suit 102 Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Michael L. Riley Jenna S. Riley
Address(number and street) Address(number and street)
102 Penster Court 102 Penster Court
City,state,and ZIP Code City,state,and ZIP Code
Richlands, NC 28574 Richlands, NC 28574
Country Country
E-mail address
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.
Signature of Seller /� / Sig Lure of Seller r
ICI Lf'I. f/ ,�^+OY� 't l A TC>I_l I
Printed Name of Seller ccff / [date Prip Name of Selig .� ale signed(mmlddlyyyy)
Michael L. Riley !r Jenna S. Riley C y�'�(`lam`� '� I 15/2 02 -
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIF H T A
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on con anI D
Mark William Mallory Mackenzie Jean Graves
Ads�(nurpbep and C Address(number and street) JqN 25 2022
\Vwilty state,and ZIP Code City,state,and ZIP Code . , .
�(cV \<c� 1 N) 14"1 1p to to y a R
Count ��I��- CountryGII380W COUNTY AUDITOR
7 Cv l tc�1 �'�
Lk Ai
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
1.Will this property be the buyers primary 0 3. Homestead
residence? p x 4. Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 x 5.Wind Power Device
for this residence?If yes, provide address: 0 x 6. Hydroelectric Power Device
Address(number and street) Q x 7. Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
6-04 - -000.631-1