Homestead_Ralph (4) H. PREPARER
Preparer of the Sales Disclosure Form Title
SHANNON M VALIANT ESCROW OFFICER
Company E-mail address
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
Eric S. Campbell Krystal D. Campbell
Address(number and street) Address(number and street)
12226 S. Brook Dr. 12226 S. Brook Dr.
City, State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 Haubstadt, IN 47639
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.
Si9 nat of Sig ture of CQ n n
ed l'Ime of Seller Date signed (mm/dd/yyyy) Printed Na e of Seller Date signed(mm/dd/yyyy)
Eric S. Campbell 7/27/2022 Krystal D. Campbell 17/27/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL 1T APPLY
'emu Di
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appears on c ati_69 document
Eric J. Ralph Lisa D. Potts-Ralph j}.z,Ow
Address (number and street) Address(number and street) „
208 N. Race St. 208 N. Race St. 'CO
City, State and ZIP Code City, State and ZIP Code 9n-
Princeton, IN 47670 Princeton, IN 47670 -Country Country 7/-
United States of America United States of America
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
W ❑ 1. Will this property be the buyer's primary residence? _V. 0 3. Homestead
El -gi. 4. Solar Energy Heating or Cooling System
0 2. Does the buyer have a homestead to be vacated for 0 (t 5. Wind Power Device
this residence? If yes, provide address:
0 ® 6. Hydroelectric Power Device
Address(number and street) ❑ It 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county 0'W-k
Zl.,- '. S‘.Q_- ILC-)fl - 0n.4- r l,25-
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 duction is bein filed �
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