Homestead_Green (5) 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
Keith Edward Perkins
Address(number and street) Address (number and street)
231 E. Columbia St.
City, State and ZIP Code City, State and ZIP Code
Oakland City, IN 47660 '
Country Country
United States of America I Telephone number
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.
'ignature o($e J)er /� / ( /� Signature of Seller
z u CSC .-" C/ yyyy) (mm/dd/yyyy)Date
Printed Name of Sellerr Date signed (mm/dd/ Printed Name of Sellersigned
Keith Edward Perkins 12/2/2022
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
er 1 -Naas it appears on conveyance document Bu r 2-Name as it appears on co i�y nce document
4 John Green Melissa Gree ��YY
A ress(number and street) dress (number and street)
830 W. College St.,Apt A. 830 W. College St.,Apt A. -4,4'
0e1)
City, State and ZIP Code City, State and ZIP Code C7
Oakland City, IN 47660 Oakland City, IN 47660/ ZO�Z
Country Country N
United States of America United States of America cO�Nr 'Z -
9 le hone number
to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
El ❑ . Will this property be the buyer's primary residen . El ❑ 3. Homestead
z_1:1 Q 4. nergy Heating or Cooling System
0 2. Does the buyer have a homestead to be vacated for ❑ p 5. Wind Power Device
this residence? If yes, provide address: 0 p 6. Hydroelectric Power Device
Address(number and street) ❑ Q 7. Geothermal Energy Heating or Cooling Device
�J/
City, State,ZIP code, and county --/ / 'r 3- 4V/ ok16?- *05/7
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 falsifie value of
transferred real property,or omits or falsifies any information required to be provided,commits a Level 5 felony. (N : t ouse's
information, SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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