Homestead_Houston H. PREPARER
Preparer of the Sales Disclosure Form Title
Shannon Valiant •SCCZflW 0. c p_
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
Kenneth .Jac rs F T L F,
Address(number and street) Address(number and street)
322 E. Ohio St.
City, State and ZIP Code City, State and ZIP Code OCT 2 0 2022 v�
Princeton, IN 47670
Country Country e.��
United States of America //1 4'r#1 c' ,.v'vaz'y'
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.
Signature of Seller/ Signature of Seller
Printed Name of Seller Date signed (mm/dd/yyyy) Printed Name of Seller I Date signed(mm/dd/yyyy)
Kenneth A.Jacobs 10/13/2022
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
B it appears on conveyance document Buyer 2—Name as it appears on conTe�r11�e lociu tD
Eillowyn A. Houston Dylan R. Murphy IIFF ii
Address(number and street) Address(number and street)
2812 C St. 2812 C St. OCT 1 9 2022
City, State and ZIP Code City, State and ZIP Code
Evansville, IN 47712 Evansville, IN 47712
Country Country V&V/..a-<< c'Zy,� ,
United States of America
United States of America GIBSON COUNTY AUDITOR
YES NO CONDITION YES TIC2�N
❑ 1. Will this property be the buyer's primary residence? ❑ 3. Homestea
❑ � 4. Solar Energy Heating or Cooling System
❑ X 2. Does the buyer have a homestead to be vacated for ❑ ot 5. Wind Power Device
this residence? If yes, provide address: ❑ g. 6. Hydroelectric Power Device
Address(number and street) 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
a - /-? -/8- A0.3 _ 000. ? 68_0.l g
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