Homestead_Clark H. PREPARER
Preparer of the Sales Disclosure Form Title
Timothy Shea Settlement Agent .
Company E-mail address
Hometown Title.LLC _ _ _ -._ __ _. _ ___ _
Address(number and street city stale country.and/1P Code)
20 NW 1st Street,Suite 100,Evansville,IN 47708
I. SELLER(S)/GRANTOR(S)
Seller 1 Name as it appears on conveyance document Se Ier 2-Name as appears on nv al e do tent i
Kyle B.Cross {'
Address(number and street) Address(number and street) AUG b
AL�6 $ 0
6fiSSOld Patoka R3. 9 '
Citystate and ZIP Code City slate,and ZIP epee
Patcka,1AL47S66 ��-�#0 n-i Wo cg cC o , o F
SONC V�.L
CountryCountry NTy A
tJOITO.
US
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 falsif led,commits a Level 5 felony.
Si nature of Seller Signature of Seller
Signature 5 _ _
nnte` Name of Se let Date signed(min/dd/yyyy) Printed Name of Seller Date signed(mm/ddiyyyy)
Kyle B.Cross 08/02/2022 08/02/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1 Name as t appears on conveyance document Buyer 2 Name as it appears on conveyance document
John W.Clark
Address(number and greet O Address(number and street)
ce IS S a 1a h4-- � rip"
y stale and ZIP Code City slate and ZIP Code
Ct" t N ictC -
Country Country
US
E
E ma I address
apply for certain deductions_Identify all of those that apply: i
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary of 0 3. Homestead
® residence'? 0 CR 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 1 5.Wind Power Device
0 for this residence?If yes.provide address: 0 ll 6.Hydroelectric Power Device
Address(number and street) 0 IR 7.Geothermal Energy Heating or Cooling Device
City state ZIP code and county C�( �i Ot , l 2)- - 4OO_ coo. S2 - O2z
A ,