Homestead_McKannan H. PREPARER
Preparer of the Sales Disclosure Form Title
Jamie E. Smith Escrow Officer
Company
Address(number and street,city,state,country,and ZIP Code)
101 Plaza East Boulevard, Suite 102, Evansville, IN 47715
I. SELLER(S)/GRANTOR(S)
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance document
RANDALL THOMAS FILED
Address(number and street) Address(number and street) ■�-i -,�/)
2146 E Alford Jasper Street
City,state,and ZIP Code City,state,and ZIP Codelel
Petersburg, IN 47567-8827 DEC 0 7 2022
Country Country
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 Se i! /_ f�/ Signature of Seller
•
P nted Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
RANDALL THOMAS November 21, 2022 November 21, 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
DAKOTA L. MCKANNAN
Address(number and street) Address(number and street)
504 N Main Street
City,state,and ZIP Code City,state,and ZIP Code
Patoka, IN 47666-9516
YES NO CONDITION
1.Will this property be the buyer's primary Er. 0 3. Homestead
0 residence? D Ei 4.Solar Energy Heating or Cooling System
�f 2.Does the buyer have a homestead to be vacated Q la 5.Wind Power Device
t� for this residence? If yes,provide address: 0 E 6.Hydroelectric Power Device
Address(number and street) El 23 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county o�CQ,--13 _L(4 3 C)Z - c o o O 2�
l6Z-
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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