Homestead_Banet (2) 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
Unsupervised Estate of Roger Dwain Denbo, deceased
Address (number and street) Address (number and street)
904 S.Washington St
City. State and ZIP Code City, State and ZIP Code
Princeton, IN 47670
Country Country
United States of America
E-mail address
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.
Si lure J ., -d Pia-s' Signature of Seller
P in Na of Sr#Iler Date signed (mm/dd/yyyy) Printed Name of Seller I Date signed (mm/dd/yyyy)
QXV1 ( ED ,,C ..rig0 C kt (0/6/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-2- Name as it ears'IDENTIFY�TH.A• PLY
op.tonveyance document
Buyer 1 - Name as it appears on conveyance documentBuyer
Jordyn M. Banet `�1
Address (number and street) Address (numbed s eet) l�ti� ��
2130 Vine Ct,Apt 26 �� ��(¢-f�".; J
City, State and ZIP Code City, State and ZIP Code (///���, Y'wJ`
Princeton, IN 47670 v�'S�
O
Country Country �G
0yo
United States of America �N
E-mail address
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form may be used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
El ❑ 1. Will this property be the buyer's primary residence? El ❑ 3. Homestead
❑ El 4. Solar Energy Heating or Cooling System
0 El 2. Does the buyer have a homestead to be vacated for ❑ El 5. Wind Power Device
this residence? If yes, provide address: 0 Q 6. Hydroelectric Power Device
Address (number and street) ❑ 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county L12
_ 1^-1--/_ `O( -OQQ'--1 (--Oais)
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