Homestead_Hurst H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
Address (number and street, city, state, country, and ZIP code)
605 SE Martin Luther King Jr Boulevard, Evansville IN United States of America 47713
I. SELLER(S)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document
Mary George
Address(number and street) Address(number and street)
6956 N SR 65
City, State and ZIP Code City, State and ZIP Code
Hazleton, IN 47640 '
Country Country
United States of America
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.
yesyr f Seller Signature of Seller
Printe Name f eller Date signed(mm/dd/yyyy) Printed Name of Seller I Date signed(mm/dd/yyyy)
Ma (z.pt,,?:
George 6/14/2022
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
_John D. Hurst Monica R. Hurst
Address(number and street) Address(number and street)
3199 N. CR 200 W. 3199 N. CR 200 W.
City, State and ZIP Code City, State and ZIP Code
Petersburg, IN 47567 Petersburg, IN 47567
Country Country
United States of America United States of America
E-mail address
apply for certain deductions.Identify all of those that apply: \..n
YES NO CONDITION YES NO CONDITION 1�
p 0 1. Will this property be the buyer's primary residence? Q 0 3. Homestead ~
0 p 4. Solar Energy Heating or Cooling S I�n� o 1 Q
0N 2. Does the buyer have a homestead to be vacated for 0 p 5. Wind Power Device ?
this residence? If yes, provide address: ❑ p 6. Hydroelectric Power Device ` ~
Address(number and street) 0 Q 7. Geothermal Energy Heating or Co6RRgevic� �C
z
City, State,ZIP code, and county 26- Dip-Qe,,—,3Dp—DCp. /7 —7 !,
I herebycertifythat this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete �"
Under required byes of perjury,
as law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of
Page 3 �s '