Homestead_Rodriguez 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
Sherrill Jon Beasley
Address (number and street) Address (number and street)
506 W School Street
City, State and ZIP Code City, State and ZIP Code
Francisco, IN 47649
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.
$igna e of Seller /) Signature of Seller
PObrin ed Name of Se er U7�—�� Date sig ed�m/dd/yyyy) Printed Name of Seller Date signed (mm/dd/yyyy)
Sherrill Jon Beasley a t2q .zp ,
J. BUYER(S)/GRANTEE(S)—APPLICATION FO PROPERTY TAX DEDUCTIONS—IDENTIFY ALL TH
Buyer 1 —Name as it appears on conveyance document Buyer 2—Name as it appears o nv� ce d u
R.I/Joie/a F, r'�osaf z R 4rij e -
Address (number and street) Address (number and street) JUL
500 W Warnock Street - 08 2022
City, State and ZIP Code City, State and ZIP Code [ W�
Princeton, IN 47670 _, BSO'v r �_y �•
CountryCountry OVNT qU¢�
D/"O
United States of America
E-mail address
apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
iVf El 1. Will this property be the buyer's primary residence? tVI ❑ 3. Homestead
❑ El 4. Solar Energy Heating or Cooling System
❑ 2. Does the buyer have a homestead to be vacated for El 0 5. Wind Power Device
this residence? If yes, provide address:
❑ 0 6. Hydroelectric Power Device
Address(number and street) ❑ El 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
L Co_-1 - - z-OZ_- oc O19--ooS.
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
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