HomeMy WebLinkAboutHomestead_Staley 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. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Jake Charles
umbe Young F T L F D
Address(number and street) Address(number and street) J
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City,state,and ZIP Code ,/ City,state,and ZIP Code MAY 2 3 2022
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S.� G�g9or c�OiIt�TY AUDITOR
E-mail a dress
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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.
Si i /of {ler Signature of Seller
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anted Name of Sell Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Jakeb Charles Young 6,-'5/dz/2.1 z z
J. BUYER(S)IGRANTEE(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 Staley
Address(number and street) Address(number and street)
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City,state,and ZIP Code� / / City,state,and ZIP Code
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Country Country
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cE-mail address E-mail address Telephone number
O Pursuant to IC 6-1.1-12-44,the Sales Disclosure Forth may be used to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
O1.Will this property be the buyer's primary 0 3. Homestead
o ❑ residence? 0 O 4.Solar Energy Heating or Cooling System
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2. Does the buyer have a homestead be vacated 0 O 5. Wind Power Device
p O for this residence? If yes,provide address:to 0 f 6. Hydroelectric Power Device
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1 ((AslgreAs(number and street) 0 Q 7. Geothermal Energy Heating or Cooling Device
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( City,state,ZIP code,and county / , 0 p p-° I -(�S (1 - 0O 6
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