Homestead_McCray H. PREPARER
Preparer of the Sales Disclosure Form Title
Abbigail Moers 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
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I. — a it appears
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Seller 1 Name— as it appears on conveyance document Seller 2—Name as it appears on cony n d u t
Mackenzie Jines Dakota Jines
Address(number and street) Address(number and street) JUN 2.7 2022
6376 W. CR 100 S. 6376 W. CR 100 S.
City,State and ZIP Code City, State and ZIP Code ' `� a ,1
Petersburg, IN 47567 Petersburg, IN 47567 r "^ co:
AUDITOR
Country Country GId SON CO
United States of America United States of America
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 nature of Seller _ Suture gf eller
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ranted Name of Seller � Date signed(mm/dd/yyyy) Printed Name of S� I Date signed(mm/dd/yyyy)
Mackenzie Jines 6/21/2022 Dakota Jines 6/21/2022
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
Brianna McCray William McCray
Address(number and street) Address(number and street)
_215 3rd St. 408 S. 4th St.
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Princeton, IN 47670
Country Country
United States of America United States of America
❑ . Will this property be the buyer's primary residence? ❑ 3. Homestead
El 0 4. Solar Energy Heating or Cooling System
0 2. Does the buyer have a homestead to be vacated for this 0 p 5. Wind Power Device
residence? If yes, provide address:
❑ p 6. Hydroelectric Power Device
Address(number and street) ❑ p 7. Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and county
aL-oy- 025 -l0(- bco. 0 3 -c ?O
Under penalties of perjury,I hereby certify that 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. (Note:Both spouse's
information, SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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