Homestead_Cox H. PREPARER
Preparer of the Sales Disclosure Form Title
Christa D.Tracey 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) 'V
Seller 1 -Name as it appears on conveyance document Seller 2-Name as it appears on conveyance document 0
Channon Robb �"� T
Address(number and street) Address (number and street) LF TT Fi ,�!■ \
209 N. Main St. 1 1 L 1 J
City,State and ZIP Code City, State and ZIP Code
Haubstadt, IN 47639 , NOV 2 2 202 \ (�
Country Country �J
United States of America tThc� J�i�1 a ,i
the best of my knowledge and belief, is true,correct and complete as
r aired 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
r al vro rty,or omits or falsifies any information required to be provided,commits a Level 5 felony.
i ntu o Selle Signature of Seller
s 11 _ 1�( 2L
Printed Name of Sel Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Channon Robb I
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
Abigail Cox
Address(number and street) Address(number and street)
68 W.800 S.,APT 8104
City,State and ZIP Code City, State and ZIP Code
Fort Branch, IN 47648
Country Country
United States of America
to apply for certain deductions.Identify all of those that apply:
YESy NO CONDITION YES.., NO CONDITION
la/ 0 1. ill this property be the buyer's primary residence? �E 0 ..3. Homestead
❑ lH' 4. Solar Energy Heating or Cooling System
0 2. Does the buyer have a homestead to be vacated for ❑ �5. Wind Power Device
this residence? If yes, provide address: 0 L -'6. Hydroelectric Power Device
Address(number and street) 0 V . Geothermal Energy Heating or Cooling Device
City,State,ZIP code,and county AC-0 -3\_3Ol -
COO.
OO` O O3 -fx"Q
Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete
C 0 PY