Homestead_Blythe H. PREPARER
Preparer of the Sales Disclosure Form TitleESCROW OFFICER
SHANNON M VALIANT
Southwestern Indiana Land Title
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
Krimson R. Bailey
Devyn R. Bailey
Address(number and street) Address (number and street)
2532 S Old State Rd. 2532 S Old State Rd.
City, State and ZIP Code City, State and ZIP Code
Owensville, IN 47665 Owensville, IN 47665
Country
Country
United States of America United States of America
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signatu e f a ------ Signatu o,f_2Seller n
•- ' /J Date signed(mm/dd/yyyy)
Printed elle - Date signed (mm/dd/yyyy) Printed Name of Seller ' Date
Devyn R. Bailey
8/4/2022 Krimson R. Bailey
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 2-Name as it appears on c�11+ ance document
Buyer 1 -Name as it appears on conveyance document Y
DamiendesM. e
Address(number and street) Address (number and street)
2415 Long Point Dr. Lpi)
4!/r
City, State and ZIP Code City, State and ZIP Codecii J ,
Evansville, IN 47715 o2Z
Country Country G' ON cOVNT� .
United States of America '��4" ione n er
E-mail address
to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
❑ 1. Will this property be the buyer's primary residence? fp, ❑ 3. Homestead
❑ E 4. Solar Energy Heating or Cooling System
❑ r' 2. Does the buyer have a homestead to be vacated for 0 5. Wind Power Device
this residence? If yes, provide address: 0 fSil. 6. Hydroelectric Power Device
Address(number and street) 0 V3 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code,and county Q (_ \1-30 -2.00 -00 5- . 66 ?3— O 2k .
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