Homestead_Mason (2) H. PREPARER I
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
Jessica C. Sherman
Cainen Sherman
Address (number and street) Address (number and street)
10206 E. 250 S. 10206 E. 250 S.
City, State and ZIP Code City, State and ZIP Code
Oakland City, IN 47660 Oakland City, IN 47660
Country Country
United States of America 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.
Si nature of Seller ig atur of Seller
Date signed (mm/dd/yyyy) Printed e of Seller Date signed (mm/dd/yyyy)
Printed Nameof Seller g Jessica Sherman 7/8/2022
Cainen Sherman 7/8/2022
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 c - ce document
Ethan Mason Sydney Corn 11 T
Address (number and street) Address (number and street)
6753 S. 350 E. 6753 S. 350 E. ✓(/� `�
City, State and ZIP Code City, State and ZIP Cod 13
FortCountry nch, IN 47648 Co Branch, IN 47648C/9SONntry c— . <20?
United States of America United States of America y o
tiv
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
p 0 1. Will this property be the buyer's primary residence? O RI 4. Solar Energy Heating or Cooling System
❑ El 2. Does the buyer have a homestead to be vacated for 0 RI 5. Wind Power Device
this residence? If yes, provide address: ❑ p 6. Hydroelectric Power Device
Address(number and street) 0 El 7. Geothermal Energy Heating or Cooling Device
City, State, ZIP code, and county 3l� D- ��
��--V - � -'A c
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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