Homestead_Payne (2) H. PREPARER
Preparer of the Sales Disclosure Form Title
Stacey Salzman Settlement Agent
.... _._ny m -_ _.
Company
Address(number end street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Blaine M.Gooch Jaclyn Gooch
Address(number and street) Address(number and street)
507 W.Monroe St. 507 W.Monroe St.
City,state,and ZIP Code City,state,and ZIP Code
•
Princeton,IN 47670 Princeton, IN 47670
Country Country
US US
E-mail address
real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
'nature o Seller Sig ure el Seller
Printed Name of Seller Date signed(mm/dcLryyyy) Print Nam& Seller Date signed(mmtddlyyyy)
Blaine M.Gooch 09/16/2022 Jaclyn Gooch 09/16/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conve rice document
Zachary Payne j11.e__
Address(number end street) Address(number and street)
316 W.Emerson St.Apt E _
City,slate,and ZIP Code City,state,and ZIP Code SksP_ s -1) .
Princeton,IN 47670 2p
Count Country 22
ry
US
apply for certain deductions.identify all of those thi' p :
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary ® 0 3. Homestead
® O residence? O ® 4, Solar Energy Heating or Cooling System
2. Does the buyer have a homestead to be vacated 0 f 5.Wind Power Device
0 ® for 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 (DC-V2 - 07_20Z - OO2 - GC3 -02'8 -
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,Is true,correct and complete
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