Homestead_Davis (20) H. PREPARER
Preparer of the Sales Disclosure Form Title
Christina Gourley Title Clerk
Company
Address(number and street,city,state. country,and ZIP Code)
4600 Washington Ave, Suite 102, Evansville, IN 47714R r�
I. SELLES)/GRANTOR(S) rED
Seller 1—Name as it appears on conveyance document Seller 2—Name as appears on conveyance
Jeffrey D. Roberts Dale E. Roberts
Address(number and street) Address(number and street) JAN 1 8 2023
(-( 80 o uxh 50 �t)
City,state,and ZIP Code City,state,and ZIP Code.
0 IMJnsv► lie 1 T� -17(ptoS ti lQ /x�
Country Country pUN AUDt o
E-mail address
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 pr vided,commits a Level 5 felony.
A,'Signatur f Seller T_ Si ure of Selle /
P 1 of Seiler Date signed(mm/dd/yyyy) Printed Name of Seller Cr^L�DC�If Date signed(mm/dd/yyyy)
of r y D. Roberts (-177-a 3 Dale E. Roberts I--1 -4?-7?
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
Kristopher Davis Kasandra Davis
Address(number and street) f a e Address(number and street)
L 1 q4 1--)
City,state,and ZIP Code f O� City,state,and ZIP Cod
V' r i n(,cm a ,T,J �+�'
Country Country
E-mail address
apply for certain deductions.Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
X O 1.Will this property be the buyer's primary
tfiiC
O 0 3.Homestead
residence? l J 4.Solar Energy Heating or Cooling System
O s2.Does the buyer have a homestead to be vacated 0 D 5.Wind Power Device
for this residence?If yes,provide address: 0 C) 6.Hydroelectric Power Device
Address(number and street) p p 7.Geothermal Energy Heating or Cooling Device
City,state,ZIP code,and county r —V\--\'l _
— `Q O_ 0 O\ '5O S — O 2 k
Under penalties of perjury,I hereby certify that this Sales Disclosure,to t abbest of my knowledge and belief,is true,correct and complete
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