Homestead_Green (2) t
4ry fix
Preparer of the Sales Disclosure Form Title
Jessica Bala] Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
5231 Oak Grove Road,Suite A,EvansvNle, IN 47715
j SELLER(S)/GRANTOR(Sj..... ' ~. . .. _.,.., . ._ , .
Seller 1—Name as I appears on conveyance document
Southern Homes Renovations LLC Seller 2—Name as appears on conveyance document
Address(number and street)
Address(number and street)
City,state,and ZIP Code
City,state,and ZIP Code
Country Country
United States of America United States of America
certi this:Sales Afsc{osul�e fo the best of my knowledge:"arid belief r�true oofrect and=complet¢'as-":
:Under penalt+es�of penury Y _ �
required_by law and Js-prepafed in,accordance with IC:6'111 5 5 A person Who'knowin'gly and.Intentionally OIstfies thr _value of transferred
=real pr`44per4y,,or omits or fals'ifte4 any information requited to.be;pi ovided Commits a Level 5-felony, - -
Signature of Seller Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
David Wilcox i
`J BUYER(S)JGRANTEE(S)- _AP.PL7CATIO N FOR PROPERTY TAX!DEDUCTION:S IDj NTtP CYALL THAT APPLY
Buyer 1—Name as It appears on conveyance document Buyer 2—Name as appears on conveyors er 'E D
Cicily Green
Address(number and street) Address(number and street)
400 N.Church Street J U N 1 5 2022
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648 /�
Country Country C..li. i'4,&L
United States of America United States of America GIBSON COUNTY AUDITOR
E-mail address
for certatii•dedutions, Identify al)of thoealiatapptyt?
YES NO CONDITION YES/` NO CONDITION
[1 ❑ 3.Homestead
0 1.Will this property be the buyer's primary residence? 0 Q 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated for 0 Q 5.Wind Power Device
❑ Q this residence? if yes, provide address: ❑ E 6. Hydroelectric Power Device
Address(number and street) 0 Q 7. Geothermal Energy Heating or Cooling Device
City,state,and ZIP Code County
r
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