Homestead_Rodgers •
H. PREPARER
Preparer of the Sales Disclosure Form Title
Gwyn Shaw Escrow Officer
Address(number and street.city,state,country,and ZIP Code)
5231 Oak Grove Road,Suite A,Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document
Greg A.Pohl Seller 2—Name as appears on conveyance document
7 Ad�re�s(number and street)
t (nu WI p ry, OO N, Address(number and street)
City 1 e,a ZIP Coda ��,ry
City„state, � 1 0 ltec-N City,state,and ZIP Code
Country Country
United States of America United States of America
E-mail address
Under penalties of perjury, I hereby certify this Sales Disclosure,to the best of my knowledge end 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...Seeller Signature of Seller
Printed Name of Seller �Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Greg A.Pohl Xl O.-" l —22-
J. BUYER(S)IGRANTEE{S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTI THAT APPLY,Lao
Buyer 1—Name as It appears on conveyance document Buyer 2—Name as appears on conveyance 0 nt "I-1
Ginger Rodgers ImIiI14
Address(number and street) Address(number and street) n W I4 10862 S 150 W O ~
City,state,and ZIP Code City,state,and ZIP Code -i ry tillHaubstadt,IN 47639 '� o L
Country Country O ry
eizi
United States of America United States of America t
certain deductions:;Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 ❑ 1.Will this property be the buyer's primary residence? ® 0 3.Homestead
0 0 4.Solar Energy Heating or Cooling System
❑ ® 2.Does the buyer have a homestead to be vacated for 0 05.Wind Power Device
this residence?If yes,provide address: 0 El 6.Hydroelectric Power Device
Address(number and street) 0 0 7.Geothermal Energy Heating or Cooling Device
City,state.and ZIP Code County ca( 2Z-12 r to 0-00 ' '423 `0 2-4
Under penalties of perjury,I hereby certify that •
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 1C 6-1.1-5.5. A person who knowingly and intentionally falsifies the value of
trans d real property,or omits or falsifies any Information required to be provided, commlte a Level 5 felony. (Note: Both spouse's
in ,SSN/Drfver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
—. •