Homestead_Cox H. PREPARER
Preparer of the Sales Disclosure Form Title
Kandace Rogers Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4905 Theater Drive, Evansville, IN 47715
I. SELLERS)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
Jennifer Kolb pi_
Address(number and street) Address(number and street) 1...
902 Cate, a and ZIPw Drive
City,state, Code City,state,and ZIP Code
Fort Branch, IN 47648 `SFp?
CountryCount `9�
Country 4/ZZ ( 7
USA \
UNryI��_y
--
Under penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,is true,corprcec ' '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 val a of transferred
real property or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signature of r Signature of Seller
Pn ed N m Se Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Jenni Kolb 09/23/2022 09/23/2022
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 conveyance document
Jared Paul Cox
Address(number and street) Address(number and street)
102 South Walters Street
City,state,and ZIP Code City,state,and ZIP Code
Fort Branch, IN 47648 —•
Country Country
USA
_ YES NO CONDITION
® ❑ 1.Will this property be the buyer's primary ❑X ❑ 3. Homestead
residence? ❑ n 4_ Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated ❑ 0 5.Wind Power Device
❑ for this residence? If yes,provide address: ❑ Q 6. Hydroelectric Power Device
Address(number and street) n n 7. Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county a -` 1-I"R-
1"R- 3 Q3 --COO ( i zs _ (326
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