Homestead_Rutko H. PREPARER
Preparer of the Sales Disclosure Form Title
Gwyn Shaw Escrow Officer
Company
_
Address(number and street,city,state,country,and ZIP Code)
5231 Oak Grove Road,Suite A,Evansville,IN 47715
I. SELLEMSYGRAPITOR(S)
Seller 1-Name as it appears on conveyance document
Benjamin Billings Seller 2-Name as appears on conveyance d
-C-o- 1.111
Address(number and street) cn
9977 S Watertower Dr Address(number and street)
=
City,state,and ZIP Code
Haubstadt,IN 47639 1 City,state,and ZIP Code
Country Country -<, ' . CI tri
United States of America United States of America - ."... r...,
..1 r-..a
E-mail address
best of ray knowledge and belief,is'true, correct and complete as
remilred by law,and Is prepared In accordance with IC 6-1,1-55.A person who knowingly and intentionally-faialties the value of transferred
real property„or omits atfalsifies any information required to provided,commits a Level 5 felony.
Sigigure..of Sella? 11-.0. :1 Signature of Seller
_
PrintedrEUTIO of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/ddlyyyy)
Benjamin Billings i- ..).S-
J.aliYERASYGRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS....IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as appears on conveyance document
Jordan Rutko Brianna Grimm
_
Address(number and street) Address(number and street)
602 S.Mill St.ent 602 S.Mill Street
City,state,and ZIP Code City,state,and ZIP Code
OwerisvIlle.IN 47665 Owensville,IN 47665
Country Country
United States of America United States of America
E-mail address
YES NO CONDITION I YES NO CONDITION
EZI 0 3.Homestead
Ei 0 1.Will this property be the buyer's primary residence?
0 El 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated for 0 Ea 5.Wind Power Device
0 El this residence?If yes, provide address: 0 I1 6.Hydroelectric Power Device
Address(number and street) 0 El 7.Geothermal Energy Heating or Cooling Device
City,state,and ZJP Code County
, () -17-)L- 4/0o-0 ot-i .2-62- 02-2-
Under perialtleti of,pedury,I hereby-certify that thieSales Disclosure,to the tiestot My knowledgeend belief,Is true,'correct and complete
as reqUilred by law, and Is prepared In accordance with IC 6-1-.1-505. 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 hitionY. (Note: Both spouse's
Infottriatton,.SSIVIDElver's.LIdensedDlOther.Number is necessary if a Homestead Deduction Is being Med.)
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