Homestead_Dyke H. PREPARER 1
I Preparer of the Sales Disclosure Form Tale
Kelly Norton Escrow Officer
Company
Address(number and street,city,state, country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on
lF1 V�a e dointni, 1
PETER B. ETOLEN
Address(number and street) Address(number and street)
308 N Sixth Ave APR 2 0 2022
City,state,and ZIP Code City,state,and ZIP Code /�
Princeton, IN 47670-1037 — - -�/kf +4)
Country Country GIB' SON COUNTY AUDITOR
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
rea property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
i ature of ler _ Signature of Seller
POlt
bd
rimed Name of Seller
Dat (mm yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
PETER B.ETOLEN March 31, 2022 March 31, 2022
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
JASON W. DYKE
Address(number and street) Address(number and street)
308 N Sixth Ave
City,state,and ZIP Code City,state,and ZIP Code
Princeton, IN 47670-1037
Country Country
Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
YES O CONDITION
orYES NO CONDITION
1.Will this property be the buyer's primary ❑/❑ 3.Homestead
u ❑ residence? 0 EK4.Solar Energy Heating or Cooling System
rb{ 2.Does the buyer have a homestead to be vacated ❑ 12 5.Wind Power Device
❑ for this residence? If yes, provide address: ❑ 12r 6.Hydroelectric Power Device
Address(number and street) 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county P ,k —1 Z--k Ot_0V'Z ,W 3 n-o 2 .
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
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