Homestead_Goldman H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Gourley Title Clerk
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave, Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTER(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Kaytlin R. Davis
—Address(number and.street) Address(number and street)
1"i'D Z‘amon A Nu m] a c!.
City,state,and ZIP Code City,state,and ZIP Code
WrideS.J It 1 N y -R035
Country Country
int
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.
S' ature of Seller Signature of Seller
rinted Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/ddlyyyy)
Kaytlin R. Davis '.; 'Ij 2 2,
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1—Name as it appears on conveyance document Buyer 2—Name as it appears on conveyance document
Steven AustinGoldman FILED
A��s�number and street) Address(number and street)
ccr,Ss cSi
v"Ci state,and ZIP Code /� City,state,and ZIP Code APR 1 4 2022
a h e;s fo/ /l/ 4/7
ou try n Country e��
5.
E-mail address GIBSON C,v S phone
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 E
NO CONDITION
O 1.Will this property be the buyer's primary 0 3. Homestead
residence? 0 O 4. Solar Energy Heating or Cooling System
O 2. Does the buyer have a homestead to be vacated 0 O 5.Wind Power Device
for this residence? If yes, provide address: p p 6.Hydroelectric Power Device
Address(number and street) 0 p 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county ac-vs_Zo -vn 1 --0o-0. 7 -0.3
C PVY