Homestead_Penner H. PREPARER
Preparer of the Sales Disclosure Form Title
Stacey Salzman Settlement Agent
Company
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN 47715
I. SELLERS)/GRANTOR(S) FIEFFID—
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Allen K.Campbell Sherry E.Campbell AUG OR 2022 r l
Address(number and street) Address(number and street) lye
103 W.Strain St. 103 W.Strain St. //J -
City,slate,and ZIP Code City,state,and ZIP Code GIBSON COUNTY AUDITOR
Fort Branch,IN 47648 Fort Branch,IN 47648
Country Country
US
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.
S gnalure of Seller S natur of Seller l
Cyr e� ��� am '-`�' �
P n a ai Seller Dale signed(mm/dd/yyyy) n1' Name of Sellor�- ate signed(mm/dd/yyyy)
Allen K.Campbell 08/02/2022 Sherry E.Campbell 08/02/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyor 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
Quincy Penner
Address(number and street) Address(number and street)
80 W.800 S.Apt.204
City,slate,and ZIP Code City,slate,and ZIP Code
Fort Branch,IN 47648
Country Country
US
NO CONDITION
1.Will this property be the buyer's primary iY3 0 3. Homestead
® O residence? 0 ad 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 Cid 5.Wind Power Device
0 ® for this residence?IT yes,provide address: 0 ® 6.Hydroelectric Power Device
Address(number and street) 0 ® 7.Geothermal Energy Heating or Cooling Device
City,state.ZIP code,and county Rt-1$ -211-L0 2-0 0 0 2 8 4 ^d 2 6
c 4:1 �•.
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