Homestead_Goldsberry H. PREPARER
Preparer of the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
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
Millette Holderbaugh
Address(number and street) Address(number and street)
208 N East Mill St.
City, State and ZIP Code City, State and ZIP Code
Patoka, IN 47666 '
Country Country
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.
i natu a of Seller, Signature of Seller
I.Y r-A 14me �6( Date signed (mm/dd/
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller 9 yyyy)
Millette Holderbaugh 9/6/2022
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT A Pll
r 1 —Name as it appears on conveyance document PP d nt Buyer 2—Name as it appears on conveyance
Nickolas G. Goldsberry `}Fp '
Address(number and street) Address(number and stre�,l9 ''1.
709 S. 13th St. S0, c ZQZ�
City, State and ZIP Code City, State and ZIP Code o . Y-IC
Vincennes, IN 47591 A
Country Country &O,
United States of America
used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
0 0 1. Will this property be the buyer's primary residence? 0 0 3. Homestead
0 0 4. Solar Energy Heating or Cooling System
0 0 2. Does the buyer have a homestead to be vacated for 0 0 5. Wind Power Device
this residence? If yes, provide address: ❑ 0 6. Hydroelectric Power Device
Address(number and street) 0 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
P,(p -Cy -aLA - co - DC,p . 19 1 -Can.
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
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