Homestead_Gore 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
Robin Saulton pit
Address(number and street) Address(number and street)
//)��)
12Lafayette Circle
v
City.State and ZIP Code City,State and ZIP Code oc
Hurricane,WV 25526 Sep.8
Country Country e0
United States of America G!ezl01/ eph nGe number
and belief,i true,corm transferred
lete as
required by law,and is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionallyfalsifies the valu
real pro erty,or omits or falsifies any information required to be provided,commits a Level 5 felony.
5i re of Seller Signature of Seller
Printed
Name of Sel r l ,,Date et//ef sisn�edynmrdd/yyyy) Printed Name of Seller I Date signed(mm/dd/yyyy)
Robin Saulton r/\ / a5c2,v1 -
IJ. BUYER(S)/GRANTEE(S)-APPLICATION FOR PR PERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY —
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
l homes W.Gore
Address(number and street) Address(number and street)
2122 W.Virginia St.
City.State and ZIP Code City, State and ZIP Code
Evansville, IN 47712
Country
Country
apply for certain deductions.identify all of those that apply:
YES NO CONDITION YES NO CONDITION
p 0 1. Will this property be the buyer's primary residence? ❑ 0 3. Homestead
0 4. Solar Energy Heating or Cooling System
❑ 0 2. Does the buyer have a homestead to be vacated for 0 p 5. Wind Power Device
this residence? If yes, provide address: 0 p 6. Hydroelectric Power Device
Addre-ss(number and street) ❑ 0 7. Geothermal Energy Heating or Cooling Device
City.State ZIP code,and county D,r--fl- 2--d4 -0o. S t!\ — 0 Cy
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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