HomeMy WebLinkAboutHomestead_Gentry 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 on conveyance document
Mark E. Collins Pamela J. Collins
Address (number and street) Address(number and street)
3811 E 175 S. 3811 E 175 S.
City, State and ZIP Code City, State and ZIP Code
Francisco, IN 47649 Francisco, IN 47649
Country Country
United States of America United States of America
E-mail address
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 r its or f ' ie ny information required to be provided,commits a Level 5 felony.
tSypnatur 4rn
S�nature Seller
Printed N Sell r Date signed(mm/dd/yyyy) Printed Name of Seller 0 Date signed(mm/dd/yyyy)
Mark E. Collins
4/5/2022 Pamela J. Collins 4/5/2022
J. BUYS 4.)/ GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
er 1 -Name as it ap ears on conveyance document Buyer 2-Name as it appears on conveyance document
Jered Gentry
ess and street) Address(number and street)
52 St. /
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
4474)
Country Country 4p
United States of America /f 0,��2�ahone number
E-mail address
ON r,O
Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.hoitki pf those that apply:
'A • t'n/TO'naJ
YES NO CONDITION R
21 ❑ 1. Will this property be the buyer's primary residence? 0 ❑ 3. Homestead Heating or Cooling System
❑ 0 2. Does the buyer have a homestead to be vacated for El El 5. Wind Power Device
this residence? If yes, provide address: ❑ p 6. Hydroelectric Power Device
Address(number and street) El 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county (77‘ //_D -jU,,5- /x �_�-8,,,f - ��,P
Under penalties of perjury, I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete