Homestead_Capehart (3) H. FREPARER
Propanorof the Sales Disclosure Form Title
Matthew Jarvis Escrow Officer
Company
Address (number and street, city, state, country, and ZIP code)
GO5SE Martin Luther King Jr Boulevard, Evansville |N United States ofAmerica 47713
|. SELLER(S)/GRANTON(G)
Seller 1 -Name asit appears on conveyance document Seller u Name as it appears o ce document
Kristen K. Bailey ~
_tz
Address (number and street) Address(number d street)
7718 Hwy GO ^��.
City. State and ZIP Code and ZIP Code
-:^��
VVadeavi||e. |N 47638 .
Country Country
United States ufAmerica ^
E-mailddreoo
of my knowledge and belief, is true, correct and complete as
required by law,and in prepared in accordance with lC 6-1.1-5.6.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.
,� f ,/ Signature of Seller
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P�r�edNomoo7So||ar /l Date signed(mmm� A�y� PhntedName ofSeUer Date signed (mm/uu�yyy)
U
Kristen K. Bailey `' 3/31/2023
J. BUYER(S)/GRANTEE(S) �� RTY TAX DEDUCTIONS-IDENTIFY ALL THAT/\PpLY
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Buyer1 -NamouxitappoarounQ�/"��^n�e ^o���o Buyer2-Namooaitappoorn0000nveyonoadocumont
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n [N Copehu� JnnnoR� Capaha�
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vAddress (number and street) 8p0 � � yOyn Address(nun�be/and obee�
3298. 5thAve..Apt 4O APR � � �"�� 329G.5thAvo,Apt 48 `
City, State and ZIP Code City, State and ZIP Code
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Princeton, |N 47O7O / / '�� Princeton, 47O7O �
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Country COUNTY AU--~"~ Country
nunry u//o�
YES NO CONDITION
0 O 1. Will this property ba the buyer's primary residence?- ~ G] O 3. Hum���l� _�5
O 2 4. Solar Energy Heating or Cooling System
O Gg 2. Does the buyer have o homestead tobe vacated for O E2 5. Wind Power Device
this residence? |f yes, provide address: [] G] V. Hydroelectric Power Device
Address (number and street) O 0 7. Geothermal Energy Heating or Cooling Device
City, State,ZIP code, and county
. 0 - � � x 0 . Li� � ~���
Under penalties uf perjury, | hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete