Homestead_White (23)•
H. PREPARER
Preparer of the Sales Disclosure Form Title
Amy B.Pollard _ AgentCompany
_______. _, _,_-_ _. _ _ _,. -...--_ . Telephonenumber
Company E-mail address
Regional Title Services LLC
Address(number and street,city.state.country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715 T
I. SELLERS)/GRANTOR(S) ■�-L)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Gregf M.Lewis Jackie T.Lewis DEC A 7 2o22a
Address(number and street) Address(number and street)
2007 S Main Street J 2007 S Main Street
City,stale.and ZIP Code -City,state,and ZIP Code -tune a. "u)
Princeton,IN 47670 Princeton,IN 47670 GIBSON COUNTY AUDITOR
Country
Country US
US
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.
V`SJicyiy�lure of Selleratu of Seller
J'l�// r
9
Print me of Seller I Date signed(mm/dd/yyyy) Prince alma
ofa � Date signed(mmlddlyyyy)
Gregory M.Lewis
12/02/2022 Jackie T.Lewis 12/02/2022
-------
J. BUYER(S)IGRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer I-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
Adam R.White
Address(number and street) Address(number and street)
PO Box 182 _ -- —
City,state,and ZIP Code City.state.and ZIP Code
Patoka,IN 47666 _- -_—__ -- - —
Country — -- ' -- ,-Country
US Telephone number
to apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
1.Will this property be the buyer's primary
I 0 3. Homestead
O residence? 0 C7 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated
0 a 5.Wind Power Device
O r this residence? If yes,provide address: 0 a 6.Hydroelectric Power Device
Address(number and street) 0 CR 7.Geothermal Energy Heating or Cooling Device
City.slate,ZIP code.and county , IC 'V- - `� -3Q y- 001 . (3.2_5 -0 2_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
-
•
Page 3 of 5
copy