Homestead_Plunkett (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers Escrow Officer
Company
Address(number and street,city,state, country,and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTER(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
Judith Zairah Blackburn
Address(number and street) Address(number and street)
401 S.Center St.
City,State and ZIP Code City,State and ZIP Code
Fort Branch, IN 47648
Country Country
United States of America
E-mail address Telephone number E-mail address Telephone number
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.
Signature of Seller Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Judith Zairah Blackburn 1/11/2022 1/11/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPL ' I ■ r
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appears on co y^ e d
Kyle W. Plunkett
Address(number and street) Address(number and street) F LB 2 5 2022
9846 S.Watertower Dr.
City,State and ZIP Code City,State and ZIP Code ,r-,Ger al. „//k,7; ,,a,"
Haubstadt, IN 47639 GIBBON COUNTY AUDITOR
Country Country
United States of America
certain deductions.Identify all of those that apply:
YEr' NO CONDITION YE NO CONDITION
�f 0 1. Will this property be the buyer's primary residence? 0 3. Homestead
0 El 4. Solar Energy Heating or Cooling System
0 Y2. Does the buyer have a homestead to be vacated for this 0 El 5. Wind Power Device
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,State,ZIP code, and county Ds 6.-`(k—A.Ck—WV
^ 00
0 , L t 0_O 26
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 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.(Note:Both spouse's
information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
3