Homestead_Clark (7) 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 con an a oc
William H. Brown Linda J. Brown
Address (number and street) Address (number and street) MAR 5 -
1307 E.Taftown Rd. 1307 E.Taftown Rd.
City, State and ZIP Code City, State and ZIP Code
Princeton, IN 47670 Princeton, IN 47670 % rcze Caz` vrta)
Country Country GIBSON COUNTY AUDITOR
United States of America United States of America
E-mail address
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 Seller r ?•
Signat a pf Seller
,Printed Name of Seller Date signed (mm/dd/yyyy) Printed Name of S Seller?
Date signed (mm/dd/yyyy)
William H. Brown 3/10/2023 Linda J. Brown 3/10/2023
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
Samuel Lee Clark
Address(number and street) Address (number and street)
102 W Benedict St 1
City, State and ZIP Code City, State and ZIP Code
Valier, IL 62891
Country Country
United States of America
to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION YES NO CONDITION
El 0 1. Will this property be the buyer's primary residence? El 0 3. Homestead
❑ E7 4. Solar Energy Heating or Cooling System
❑ RI 2. Does the buyer have a homestead to be vacated for 0 El 5. Wind Power Device
this residence? If yes, provide address: ❑ El 6. Hydroelectric Power Device
Address (number and street) ❑ El 7. Geothermal Energy Heating or Cooling Device
1
City, State,ZIP code, and county D
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
transferred real property,or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note:Both spouse's
information,SSN/Driver's License/ID/Other Number is necessary if a Homestead Deduction is being filed.)
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