Homestead_Wilson (10) H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis 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)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as it appears o reyance document
Cameron M. Moline L E D
Address(number and street) Address(number and street)
803 McCarty Rd. MAR 2 8. lULI
City, State and ZIP Code City, State and ZIP Code 1 Z/
Princeton, IN 47670
Country Country /�Zccftal./ a. Lim a.)
GIBBON COUNTY AUDITOR
United States of America
E-mail address
.-\
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.
Vignatuye of Seller Signature of Seller
`�� <c�—
nnted Name of Seller Date signed (mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Cameron M. Moline
3/14/2022 3/14/2022
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears on conveyant cum
Harrison M.Wilson Arielle A.Wilson Address(number and street) Address(number and street) �4 422 1)
3661 E 550 S 3661 E 550 S G/Q,v Z�Z
City, State and ZIP Code City, State and ZIP Code ON
Fort Branch, IN 47648 Fort Branch, IN 47648 COOQ��4F"N)rf
Country Country AVOi
United States of America
United States of America TOR
E-mail address
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 O CONDITION
El 1. Will this property be the buyer's primary residence? El 3. Homestead
❑ IA 4. Solar Energy Heating or Cooling System
El V2. Does the buyer have a homestead to be vacated for ❑ El 5, Wind Power Device
this residence? If yes, provide address: 0 p 6. Hydroelectric Power Device
Address(number and street) ❑ 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county ' — , t --`3 _y QO _ 718)g ,, Qa—I
a O n ��t/
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
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