Homestead_Clark H. PREPARER _
Preparer of the Sales Disclosure Form Title
Amy B.Pollard _____ Settlement Settlement Agent - _._...___.._,._._.-_..--
Company
Address(number and street.city,slate.country,and ZIP Code)
7820 Eagle Crest Blvd,Suite 201,Evansville,IN 47715
I. SELLER(S}/GRANTOR(S)
Seller 1-Name as it appears on conveyance document Seller 2-Name as appea aece document
Reshay Wagner
Address(number and street) Address(number and street) k.?
104 E Kentucky Street De
City.state.and ZIP Code City.state.and ZIP Code
Princeton,!N 47670 249?� — -
Country Country Gill O '/
`SON C l!Q'//
Of )
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.
i elute of S1.ellll/gr Signature of Seller
Printed N me of CSeer-4- Date signed(mmfdd/yyyyJ Printed Name of Seller Date signed(mm/dd/yyyy)
Reshay Wagner 12/27/2022 _ 12/27/2022
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
Austin T.Clark
Address(number and street) Address(number and street)
601 Cardinal Drive
City.slate-and ZIP Code City.state.and ZIP Code
f Patoka,IN 47666
Country Country
US
apply for certain deductions.Identify all of those that apply:
YES NO TT CONDITION YES NO CONDITION
® 0 1.Will this property be the buyer's primary ID 0 3. Homestead
residence? 0 t7Z' 4.Solar Energy Heating or Cooling System
PP �n 2.Does the buyer have a homestead to be vacated 0 CR 5.Wind Power Device
Y' for this residence?If yes,provide address: 0 a 6. Hydroelectric Power Device
Address(number and street)fY — —f 0 ( 7.Geothermal Energy Heating or Cooling Device
( City,stale.ZIP code,and county 6-\ ^ _13 - 102 -0 O p ru - 32'-0
ii 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
5 C 0 PY