HomeMy WebLinkAboutHomestead_Fox (6) 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. SELLERS)/GRANTOR(S)
Seller 1 —Name as it appears on conveyance document Seller 2—Name as appears on co'l�yace ocur
Blake M. Randolph
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Address(nu/mbe and beet / Address(number and street)
112 ' "� /e el+ AUG 0 2 2022
Citfi
state,and ZI Code City,state,and ZIP Code /
41
Country 7,1 f U q7Z �� Country cfi�if &. .LD3- .--.0
GIBSON COUNTY AUDITOR
E-mail address
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Under penalties of perjury,t 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.
Signet f e]le�l� /�`K '
ed Name of Seller DateSignature of Seller
si ned(mrn/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Blake M. Randolph 7/ /?�_�
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
Meagan Leigh Fox
. dress(, t
ntumberr�and street) Address(number and street)
City,state,and ZIP Code City,state,and ZIP Code
1 Vasa s\i'i tie - —Ai LF7711
Country Country
E-mail address
for certain deductions.Identify all of those that apply:
YES _WO CONDITION NO CONDITION
O 1.Will this property be the buyer's primary y l 0 3. Homestead
residence? 0 O 4.Solar Energy Heating or Cooling System
O --2. Does the buyer have a homestead to be vacated 0 CI 5.Wind Power Device
for this residence? If yes, provide address: 0 0 6. Hydroelectric Power Device
Address(number and street) 0 O 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county
0612 ^0 l oZ, r
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