Homestead_Poff-Mcdole 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. SELLERS)/GRANTOR(S)
Seller 1-Name as It appears on conveyance document
Connor P.Tackett Seller 2-Name as appears on conveyance document
Address(number and street)
1579 S.CR 300 W Address(number and street)
City,state,and ZIP Code
Petersburg,iN 47567 City,state,and ZIP Code
Country Country
United States of America United States of America
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 6-1.1-55.5.A person who knowingly and intentionally falsities the value of transferred
real property,or omits or falsifies any.informa tion required to be provided,commits a Level 5 felony.
nature of Selje Signature of Seller
Printed Name of Seller Date signed(mndddNYyy) Printed Name of Seller Date signed(mm/d(llyly)
Connor P.Tackett "7 9-
J,BUYER(S)7GRANTEE(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 cony 77--��
Mary G.Poff-Modole ■ .L D
Address(number and street) Address(number and street)
823 N.Polk Dr
City,state,and ZIP Code City,state,and ZIP Code FEB 1 0 2022
Oakland City,IN 47660
Country Countryj�,
United States of America United States of America [a1Rot'1N' " ON `F OR
�OUNTY AUDITOR
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
Pi 1.Will this property be the buyer's primary residence? WI 0 3.Homestead
0 ® 4.Solar Energy Heating or Cooling System
❑ 2.Does the buyer have a homestead to be vacated for 0 El 5.Wind Power Device
this residence?If yes,provide address: 0 El 6.Hydroelectric Power Device
Address(number and street) 0 El 7.Geothermal Energy Heating or Cooling Device
City,stele,and ZIP Cede County �6 - -1 8 - 7-0 -coo. 3°t-0 0 4
3