Homestead_Triplett 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 appeaq:.a6eruct.
Eric McClellan fe�•r}J
Address(number and stre ) Address(number and st
to? A/0,^tLt 3 ft✓e �c
city,state,and ZIP Code City,state,and ZIP Code JUN .L 5 2022
rr,i c,ro: Zit/ LI7& 70 �7 fA 'L •,a.)
Country Country Lik l_./y W:(Y A ot
(.(.S -ciecoN C0
E-malt addre
c )
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.
4ignature of Seller Signature of Seller
06-/lo/Ao7`—
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Eric McClellan
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
Ashley Nicole Triplett
Address(number and street) Address(number and street)
t0 al c - c -t s-k
City,state,and ZIP Code` ' �I -I City,state,and ZIP Code
Co'Mry p lm N C( 4Q
Country
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 YES NO CONDITION
y{ 1.Will this property be the buyer's primary 7J," 0 3.Homestead
�l residence? 0 0 4.Solar Energy Heating or Cooling System
O 2.Does the buyer have a homestead to be vacated 0 0 5.Wind Power Device
for this residence?If yes,provide address: o 0 6.Hydroelectric Power Device
Address(number and street) 0 1 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county )1 C^1 2 -
rn y.S01, 6 4-Q
Page 3 of 5
•