Homestead_Cox H. PREPARER
Preparer of the Sales Disclosure Form Title
_Settlement Agent
Company t ��
-
Address(number and street,city,state,country,and ZIP Code)
2301 N.Burkhardt Road,Evansville,IN 47715
I. SELLERS)/GRANTOR(S) --
Seller 1-Name as it appears on conveyance document Seller 2-Name as appears on conveyance document
Corey A.Elliott
Address(number and street) Address(number and street)
City,state,and ZIP Code City,state,and ZIP Code
Country Country
US
E-mail address Telephone number E-mail address Telephone number
( ) ( )
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.
Signature of Seiler Signature of Seller
Printed Name of Seller Date signed(mm/dd/yyyy) Printed Name of Sailor at. e ned(mmldd/yyyy)
Corey A.Elliott 12/30/2022 , /30/20'
J. BUYER(S)/GRANTEE(S)-APPLICATION FOR PROPERTY TAX DEDUCTIONS-ID TIFY .. 4HA
Buyer 1 -Name as it appears on conveyance document Buyer 2-Name as it appe conveyan �ocum 4110
Jacob E.Cox Oy <-'a
Address(number and street) Address(number and street) C'Gc >
ee
tZ 4 C l�AS �'
City,slate-and ZIP Code City.state,and ZIP Code 4&77'
.
( f<ince -411In, xw, y167 0 n
Country Country
CONDITION
1.Will this property be the buyer's primary ® 0 3. Homestead
O residence? 0 ® 4.Solar Energy Heating or Cooling System
2.Does the buyer have a homestead to be vacated 0 tll 5.Wind Power Device
t] for this residence'?If yes,provide address: 0 ® 6.Hydroelectric Power Device
Address(number and street) - 0 ® 7.Geothermal Energy Heating or Cooling Device
City,state.ZIP code,and county °t/ \ 0—-_4 0'-00 0- ` i—t�2- ,